PMC8113377_01
(A) Contrast medium thoracic CT scan showing a CTAAD with a thick intimal tear (7 mm) and an enlarged ascending aorta (82 x 87 mm). The false lumen is partially thrombosed. (B) Chest X-ray showing an aortic aneurysm with a widening of the mediastinal silhouette, an enlargement of the aortic knob, and a displacement of the trachea from the midline. CT, computed tomography; CTAAD, chronic type A aortic dissection.
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F1
A aortic dissection. A 17-mm pericardial effusion was also identified (Figures 1A,B).
(A) Surgical view of the mediastinum after sternotomy. The huge aneurysm of the ascending aorta (82 x 87 mm) filled the whole cavity, displacing the heart into the left chest. The yellow arrow indicates the right atrium, and the green arrow indicates the aortic arch. (B) The ascending aorta has been replaced by the Dacron tube, leaving a free space that was previously filled by the aneurysm. The orange arrow indicates the reimplantation of the right coronary ostium.
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F2
The intervention was technically difficult, as the heart was totally displaced into the left chest, and there were strong adhesions due to chronic inflammatory reactions (Figures 2A,B).
Perioperative midesophageal long-axis view showing a thickened (5 mm) dissection flap localized in the proximal ascending aorta, immediately after the origin of the right coronary artery (blue arrow). The maximal diameter of the ascending aorta was 74 mm.
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F3
The perioperative echocardiography showed a thickened dissection flap localized just above the origin of the right coronary artery (Figure 3).
PMC8113377_02
(A) Contrast medium CT scan showing an aneurysm of the ascending aorta (53 x 54 mm) with a tear of the intima, creating a thick false lumen (4 mm), which is indicated by the purple arrow. (B) Sagittal section of the contrast medium CT scan, which also shows the aneurysm and thick tear of the intima. CT, computed tomography.
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F4
This examination unexpectedly showed an aneurysm of the ascending aorta (53 x 54 mm) with a chronic aortic dissection (Figures 4A,B).