Herein we illustrate the surgical management of a giant aortic root aneurysm with aortic dissection in a patient that had been operated on several years before due to aortic annuloectasia with an aortic valve replacement.
A 61-year-old male patient had undergone aortic valve replacement due to aortic annuloectasia using a #23 St. Jude Medical mechanical valve prosthesis. A 4.5-cm aortic root aneurysm was not removed, probably because the aortic valve was trileaflet. By 2007, the aortic root had grown to 7 cm, but surgery was not performed at another institution due to the high risk, so the patient stopped follow-up.
In 2015, the patient was admitted to our hospital with thoracic pain. Computed tomography revealed a 11.3 × 10.7 × 10.1-cm aortic root aneurysm with a Stanford Type A dissection (Figures 1 and 2). The patient underwent aortic root surgery (Figure 3) with removal of the previous prosthesis and Bentall procedure using a #21 On-X Valsalva mechanical valve conduit. The distant left main coronary ostium was easily reattached to the ascending conduit via a 10-mm interposition graft (Svensson modification ). The right coronary artery button was easily mobilized and conventionally reattached (Figure 4).
Pathology showed a chronic dissection with an intimal tear close to the origin of the left main coronary ostium. Histology showed subendothelial fibrosis with calcified areas due to atherosclerosis.
The postoperative course was uneventful, and the patient was discharged home on postoperative day 8.