Case report
A 60-year-old female was admitted to our hospital with asymptomatic complex aneurysm of the entire thoracic-abdominal aorta. Two month ago, the patient’s routine chest x-ray revealed a huge mass in the upper mediastinum (Figure 1A), and further chest CT revealed an aneurysm of the total thoracic-abdominal aorta (Figure 1B). For further surgical treatment, she was transferred to our hospital.
On admission, his vital signs were stable, no fever, no chest and abdominal pain. Blood pressure, 132/78mmHg; heart rate, 80 beats/min; temperature, 36.4℃; respiratory rate, 16 beats/min; arterial oxygen saturation on room air, 97%. The height is 162cm, the weight is 65kg, and the body mass index is 24.8kg/m2. The patient’s eye vision is normal. There was no abnormal growth in the bones of her limbs. She has a history of hypertension with well controlled. She denies that there are genetic diseases such as Marfan syndrome in her family, and she denies her personal history of drug abuse and promiscuity.
Laboratory test results are as follows: total cholesterol is 5.8mmol/L, triglyceride is 2.09mmol/L, and uric acid is 426umol/L.Transthoracic echocardiography revealed that the patient’s aortic sinus was widened (maximum diameter, 50mm) and the aortic valve was moderate regurgitation. Aortic CTA suggests aortic aneurysm, lesions involving the ascending aorta, aortic arch, thoracic-abdominal aorta, mural thrombus in the aortic arch and abdominal aorta, multiple penetrating ulcers in the thoracic-abdominal aorta, 58mm at the widest part of the ascending aorta, aortic arch 59mm in diameter, 72mm in the widest part of the thoracic aorta, and 57mm in the widest part of the subrenal abdominal aorta (Figure 1B).
Given the patient’s total thoracic-abdominal aortic aneurysm is very complicated, after thorough discussion and fully communication with the patient and family members, our group believes that the risk of one-stage total thoracic-abdominal aortic replacement surgery is very high. We finally decided to implement two-staged surgery, namely Bentall procedure and Sun’s operation in the first-stage and thoraco-abdominal aortic replacement in the second-stage. After the first-stage Bentall procedure and Sun’s operation was successfully performed, a re-examination of CTA showed that the lesions of aneurysm in the aortic root, ascending aorta, and aortic arch were well treated (Figure 2). One month after discharge, in order to avoid the rupture of the residual thoracic-abdominal aortic aneurysm, we performed the second-stage surgery namely total thoracic-abdominal aortic replacemen for the patient. Fortunately, the patient tolerated the operation well, and the postoperative CT scan showed that the total thoracic-abdominal aortic aneurysm was completely removed ( Figure 3).