A Case of Spontaneous Ascending Aortic Rupture Which Was Difficult to Distinguish from Stanford Type A Acute Aortic Dissection / 日本心臓血管外科学会雑誌

A 77-year-old man was admitted to our hospital with sudden anterior chest pain followed by shock. An echocardiography showed enlargement of the sinus of Valsalva, severe aortic regurgitation and pericardial effusion. A chest CT scan showed a crescent sign in the ascending aorta. The preoperative diagnosis was a ruptured Stanford type A acute aortic dissection and an emergency operation was performed. In the operative findings, a bloody pericardial effusion, a hematoma around the ascending aorta and a tear (less than 2 cm) of the ascending aorta just distal area of the sinotubular junction were observed. In this case, since the enlargement of the sinus of Valsalva and the severe aortic regurgitation were observed, we performed a replacement of the ascending aorta including the aortic root with an artificial vascular graft (J graft 28 mm) and a biological valve (Magna EASE 25 mm). The pathologic examinations revealed a rupture of ascending aorta in all layers and a hematoma outside the adventitia. The pathologic diagnosis showed a spontaneous aortic rupture. The postoperative course was good and he was discharged 1 month after the surgery. A spontaneous aortic rupture is defined as an aortic rupture without a trauma, an aneurysm or a dissection. It is rare but fatal and it is said that surgical treatment is necessary. We report a successful surgical case of the spontaneous aortic rupture which was difficult to distinguish from a Stanford A type acute aortic dissection.

A Case of TEVAR for Spontaneous Rupture of the Aortic Arch / 日本心臓血管外科学会雑誌

A 75-year-old man was admitted to our hospital due to sudden onset of chest pain. Computerized tomography showed penetrating atherosclerotic ulcer at the distal arch and hematoma around the aortic arch, therefore we diagnosed spontaneous rupture of the aortic arch. He had a history of previous CABG and multiple cerebral infarction with diffuse cerebral arteries. Open surgery under deep hypothermia, circulatory arrest and cerebral perfusion was considered to be difficult and too invasive, therefore we performed debranching TEVAR. Postoperative cerebellar infarction occurred, but he was discharged 29 days after surgery. TEVAR is especially useful for treatment of spontaneous rupture of the aorta in high-risk patients.