Ascending arotic aneurysms eroding sternum—Report of 3 cases managed surgically

Abstract

Background: Bentall procedure and its modification is the standard surgical management option for aneurysmal diseases involving ascending aorta and the aotic valve. The progressive nature of the aortic disease and the development of early and late procedure ralated complications warrant a dedicated clinical and investigative follow up.Methods: One hundred and forty three patients underwent composite graft replacement of the aortic root between January 1992 and June 2003. Annulo aortic ectasia was the most common lesion seen in 94 (65.7%) patients and aortic dissection in 49 (34.3%0 patients. Inclusion technique was applied in 72 patients. From June 2000 onwards, coronary button technique with no wrap was employed and total of 71 patients were operated by this method. Forty two patients underwvent repeat angiographic study during follow up visit.Results: There were 9 (6.3%) early deaths and 8 (6%) late deaths. On angiographic study, one patient operated by inclusion technique was detected to have pseudoaneurysm at the distal suture line. In another patient in this group there was a perigraft hematoma compressing the graft. In 6 patients there was evidence of disease progression in the remaining aorta.Conclusions: The coronary button technique seems to be a superior procedure for the aortic root replacement. The angiographic follow up has substantiated this.successfully operated a female with a very large renal artery aneurysm and uncontrolled hypertension of 10 years duration.Methods: A 55 year old female presented with uncontrolled hypertension for 10 years and vague lumbar pain for one year. Angiography and CT abdomen revealed a 4.8x4.5x4.3 cm saccular aneurysm arising from right renal artery. Aorta was atherosclerotic and tortuous. Aneurysmectomy with aorto renal bypass was done using saphenous vein graft. Transverse right upper abdominal incision was used and aneurysm was exposed retroperitoneally. Adhesion between renal artery proximal to aneurysm and inferior vena cava were carefully separated after identifying and saving the ureter. Proximal aortosaphenous vein anastomosis was done first applying aortic partial clamp to relatively less atherosclerotic part of arota. Renal artery was clamped and aneurysmectomy done. Distal saphenous vein to renal artery anastomosis was then performed and the renal ischemia time was only 13 minutes.Results: The patient had an uneventful recovery and her renal functions were well preserved. Her blood pressure now is well controlled without any medication one year after surgery.Conclusions: Renovascular hypertension and large size of renal artery aneurysm are strong indications for elective renal artery aneurysmectomy. Construction of proximal aorto saphenous anastomosis before cross clamping the renal artery helps in decreasing the renal ischemia time during aorto renal bypass. [----] pseudoaneurysm of LVOT-rarest presentation of aorto arteritis. Cardiac tamponade due to leaking