PMC9484867_01
The preoperative computed tomography angiogram demonstrates a large saccular aneurysm of the aortic arch with the truncus brachiocephalicus arising from the posterior part of aneurysm.
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The truncus brachiocephalicus was arising from the posterior portion of the aneurysm ( Fig. 1 ).
Intraoperative photos of the situs from the surgeon's view. (
A
) (*) indicates the large saccular aneurysm of the proximal aortic arch. (
B
) The aneurysm tissue was completely resected. (
C
) The aorta was reconstructed with pericardial patch. (#) indicates the pericardial patch.
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The pericardium was opened carefully and the saccular aneurysm in the proximal aortic arch was identified ( Fig. 2A ). The lumen of aneurysm was carefully opened and the orifice of the truncus brachiocephalicus inspected from inside ( Fig. 2B ). The irregular tissue of aneurysm was carefully resected, and the aorta was reconstructed with a glutaraldehyde-treated autologous pericardial patch ( Fig. 2C ).
Histopathology of aortic wall resected revealed partial loss of elastic fibers (
A
) Elastica van Gieson staining, x20 magnification, (#) indicates elastic fibers, (*) indicates a loss of fibers, and deposition of mucopolysaccharides. (
B
) Alcian blue staining, x100 magnification, arrows indicate deposits of mucopolysaccharides in the tunica media.
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Histological examination revealed local degeneration of the aortic wall with partial loss of elastic fibers and deposition of mucopolysaccharides ( Fig. 3A, B ). 
Follow-up postoperative transthoracic echocardiographic image demonstrated the successful result of the aneurysm resection and repair of the aorta. The arrow and additional small image shows the area of pericardial patch in the reconstructed aorta with laminal blood flow.
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At her most recent follow-up, the echocardiogram revealed no local recurrence or any other dilatation at the thoracic aorta ( Fig. 4 ).