One stage operation for aneurysm of the diverticulum of the ductus arteriosus and coronary artery bypass grafting

Abstract

Aneurysm of the diverticulum of the ductus arteriosus in the adult is rare. One stage operation for aneurysm of the diverticulum of the ductus arteriosis and coronary artery bypass grafting (CABG) is reported. A 61-year-old man was admitted for diagnosis of thoracic aneurysm on chest X-ray and CT. Chest CT scan showed an aneurysm above the left main pulmonary artery. An aortography showed the left vertebral artery originated directly from the aortic arch and a saccular aneurysm arising from the aortic isthmus and lesser curvature of the aortic arch. Coronary arteriography showed 75% stenosis at the right coronary artery (seg. #1) and 75% stenosis at the left anterior descending artery. Operation was performed through a median sternotomy. The aneurysm of 6 to 3 cm was located between the aortic isthmus and left pulmonary artery. Ascending aorta and right atrium were used to institute cardiopulmonary bypass (CPB). CABG (LITA to #7, SVG to #4 PD) was performed. Arterial cannulation was then switched to the left femoral artery. The proximal aorta was cross-clamped between the left vertebral artery and the left subclavian artery under the partial CPB, and the distal aorta was occluded with a occulusive balloon catheter via the right femoral artery. The selective left axillar artery cannulation was performed to perfuse LITA. The aneurysm was resected and closed with a patch. His post-operative course was uneventful.

Successful endovascular repair of an aneurysm of the ductus diverticulum with a branched stent graft: Case report and review of literature

“…We found 39 reports of aneurysm of the ductus diverticulum in the literature (Table ). [1][2][3][4][5][6][7][8][9][10][11][23][24][25][26] The aortic end of the ductus diverticulum is patent, whereas the pulmonary end is usually closed. The aneurysm forms as a result of incomplete closure of the ductus arteriosus in its aortic site, from pressure overload, such as hypertension and atherosclerotic changes of aging.…”

“…Most recent reports are case reports or case series of successful surgical repair. 2,[4][5][6][7][8][9][10][11][23][24][25][26] Therefore the natural history of this rare aneurysm is still unknown. The aneurysm diameter was 3.8 cm in our patient, and thoracotomy was considered too high risk because of the patient's severe pulmonary dysfunction and advanced age.…”

“…Aneurysm of the ductus diverticulum is rare in adults, and most reported cases were repaired with surgery. [1][2][3][4][5][6][7][8][9][10][11] Transluminal endovascular stent-graft placement in patients with thoracic aortic aneurysm is emerging as an attractive alternative to conventional open surgery. 12,13 However, its application is limited to descending thoracic aortic aneurysms distal to the aortic arch.…”