A Case of Ruptured Thoracic Aortic Aneurysm Requiring Two-Stage Sternal Closure due to Posterior Mediastinal Hematoma / 日本心臓血管外科学会雑誌

A 70-year-old man with severe chest pain was transferred to our hospital by ambulance. Computed tomography revealed a ruptured thoracic aortic aneurysm and massive bleeding into the posterior mediastinum. Emergency total aortic arch replacement was performed through median sternotomy. However sternal closure induced severe hypotension because the heart was elevated anteriorly by the posterior mediastinal hematoma. The hematoma could not be eliminated fully so the sternum was kept open at the first operation followed by delayed sternal closure 3 days after the operation. After that, the postoperative course was uneventful and the patient was discharged on postoperative day 43.