Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843

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Ruptured Huge Complex Aortic Arch Aneurysm Associated With Aortic Coarctation
Kunitaka KumagaiYuichiro KishimotoTakeshi OnoharaNaoki SumiYasushi Yoshikawa
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JOURNAL OPEN ACCESS FULL-TEXT HTML Advance online publication

Article ID: CJ-24-0594

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A 50-year-old woman presented to the emergency department with thoracic and back pain. Contrast-enhanced computed tomography (CT) revealed a 9-cm aortic aneurysm between the left common carotid and left subclavian arteries. An accompanying hematoma indicated a ruptured aortic arch aneurysm. Concomitantly, aortic stenosis was identified above the left subclavian artery, confirming a diagnosis of aortic coarctation. Both the aneurysm and hematoma exhibited mass effects on the main pulmonary artery, causing occlusion of the left pulmonary artery and the persistent left superior vena cava. Furthermore, the aortic arch exhibited severe kinking, forming an M-shaped configuration (Figure A–D).

Figure.

(A,C) Kinking (red dotted arrows) in the distal aorta from the left carotid artery. (A,B,DF,H) Aortic coarctation (blue arrows) in the proximal aorta from left subclavian artery. (A,B) The main pulmonary artery (+) is compressed and the persistent left superior vena cava (*) is occluded.

Given these findings, stent grafting was deemed unsuitable, and graft replacement was elected. Median sternotomy was performed, and despite visualization of the aortic coarctation, a distal anastomosis was constructed above the coarctation due to difficult dissection from the deep operative field (Figure E,F). The graft was extended to allow for possible additional thoracic endovascular aortic repair, and partial arch replacement was performed (Figure G). Postoperative contrast-enhanced CT demonstrated improved blood flow to the left pulmonary artery (Figure H).

The patient was discharged without complications 2 weeks postoperatively and remained well during the 6-month follow-up period without evidence of heart failure attributable to residual aortic coarctation.

This report highlights that although aneurysms associated with aortic coarctation typically involve the ascending or descending aorta,1 they can also involve the aortic arch. The intricate aortic anatomy in such cases requires careful surgical planning and execution.

Acknowledgments / Disclosures / IRB Information / Data Availability

None.

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