Successful Urgent Surgical Repair of an Intact 11.2-cm Ascending Aortic Aneurysm with Severe Secondary Aortic Regurgitation: A Case Report

Abstract

Giant ascending aortic aneurysms (>10 cm) are uncommon because most thoracic aortic aneurysms are detected or become complicated before reaching this size. Nonspecific cardiopulmonary symptoms and mass effect may dominate their clinical presentation. A 44-year-old man with a 2-month history of progressive retrosternal discomfort, dyspnea, fatigue, and reduced exercise tolerance was transferred urgently after an acute worsening of chest pain and dyspnea. He had previously been treated empirically for presumed atypical pneumonia without improvement. Computed tomography angiography demonstrated an intact, non-dissected proximal ascending aortic aneurysm measuring 10.7×11.2 cm, without contrast extravasation or periaortic hematoma. Transthoracic echocardiography demonstrated severe secondary aortic regurgitation, marked left ventricular dilation (LVEDD 7.0 cm; LVEDV 189 mL), and an LVEF of 45%. After blood-pressure control and hemodynamic stabilization, the patient underwent urgent composite aortic root/ascending aortic replacement using a Bentall technique with a 25-mm mechanical bileaflet valve and a 30-mm woven Dacron graft. Myocardial arrest was achieved with ostial Del Nido cardioplegia. The patient was extubated 4 hours postoperatively. At 3 months, he reported complete resolution of dyspnea and chest pressure and was in NYHA functional class I. Follow-up CTA demonstrated stable graft reconstruction without perigraft collection, pseudoaneurysm, or prosthetic dehiscence. This case illustrates that an intact giant ascending aortic aneurysm may present with misleading respiratory symptoms and severe secondary aortic regurgitation. Prompt cross-sectional imaging and definitive surgery can achieve a favorable early outcome even in extreme aortic dilation. No causal inference regarding the superiority of a specific cardioplegia strategy can be made from a single case.