PMC9996118_01
Computer tomography images (cross-section for Panel A and longitudinal-section for Panel B) of a giant floating thrombus from the ascending aorta to the arch.
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fig1
The contrast-enhanced computer tomography of the whole aorta revealed a low-density lesion without enhancement from the ascending aorta to the arch and ruled out the possibility of malignancy (Figures 1A,B). However, a large infarct area in the left cerebral hemisphere with scattered hemorrhagic lesions was observed on admission by the cerebral computed tomography, and surgery was therefore postponed for 3 weeks (Supplementary Figure S1).
The surgical procedure in a patient with a giant thrombus from the ascending aorta to the arch. Panel A, the cannulation strategies for bilateral cerebral perfusion; Panel B, the giant floating thrombus attached to the aortic wall of the ascending aorta; Panel C, the giant thrombus measuring 9*4 cm in size; Panel D, the aortic wall reconstruction using a bovine pericardial patch; and Panel E, pathological evaluation of the thrombus in hematoxylin and eosin staining. Abbreviations: RA, right atrium; DHCA, deep hypothermic circulatory arrest; BCA, brachiocephalic artery; LCCA, left common carotid artery; LSCA, left subclavian artery.
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fig2
The femoral artery was used to perfuse the body, while the brachiocephalic artery and the left common carotid artery were cannulated for bilateral cerebral perfusion (Figure 2A). We removed the floating mass via aortotomy without aortic cross-clamping, which was 9*4 cm in size and was attached to the wall of the ascending aorta (Figures 2B,C). The site of attachment was further excised, and the wall of the ascending aorta was reconstructed using a bovine pericardial patch measuring 5*5 cm in size (Figure 2D). Pathological examination confirmed that the red-yellow mass was a thrombus (Figure 2E). Neither atherosclerotic plaque nor endothelial injury was seen in the thrombus-aortic wall attachment zone (Supplementary Figure S2).