PMC9997479_01
Preoperative and postoperative imaging. (a) A preoperative chest X-ray shows moderate scoliosis and an enlarged cardiac silhouette due to the aortic aneurysm shadow. (b) A preoperative computed tomography (CT) scan clip shows a large ascending aortic aneurysm (94 mm x 78 mm), closely related to the internal table of the sternum. In the back of the aneurysm, the distal trachea is partially occluded due to external compression (white arrow). (c) A preoperative CT 3D reconstruction reveals an aneurysm that extends through the ascending aorta to the arch with evident aneurysmal dilation of both coronary ostia. (d) A postoperative CT clip shows the relief of the airway compression (white arrow) by the replacement of the aneurysm with a tube graft along with the aortopexy
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F1
The large ascending aortic aneurysm caused an extrinsic compression of the distal trachea (minimum anteroposterior diameter of 2 mm) and displaced the pulmonary artery leftward [Figure 1a-c]. Finally, the ascending aortic graft was wrapped with the remains of the ascending aortic aneurysm tissue as an aortopexy to decompress the trachea and definitively solve the ventilatory problem [Figure 3, Figure 1d].
Intraoperative fiberoptic bronchoscopy. (a) The tracheal lumen, at the level of the carina, is almost completely occluded due to the extrinsic compression by the aneurysm. (b) Relief of the airway compression after the aortopexy
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F2
Fiberoptic intubation was performed and a 7 mm ETT was placed, an extrinsic compression of the carina was visualized distal to the tip of the ETT, which occluded the tracheal lumen almost completely and was accompanied by tracheomalacia [Figure 2a]. The intraoperative fiberoptic bronchoscopy (FOB) confirmed a significant improvement in the diameter of the trachea after the aortopexy [Figure 2b].
Surgical view of the aortopexy. The remains of the aortic aneurysm tissue surround the aortic graft to bring the aorta away from the airway toward the sternum, thereby, increasing the airway lumen
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F3
Finally, the ascending aortic graft was wrapped with the remains of the ascending aortic aneurysm tissue as an aortopexy to decompress the trachea and definitively solve the ventilatory problem [Figure 3, Figure 1d].