Aortic Patch Repair and Bronchial Stenting for a Giant Thoracic Aortic Aneurysm with Airway Obstruction

Motohiro Maeda＊

Jiro Honda＊

（Cardiovascular Surgery, Nakagami Hospital, Okinawa, Japan）

A 62-year-old woman with severe breathlessness was admitted to the emergency department. Computed tomography revealed nearly complete airway obstruction by a giant thoracic aortic aneurysm, measuring 90 mm in diameter. Previously, she had undergone hemiarch replacement for acute aortic dissection and was not attending follow-up consultations for personal reasons. Owing to the excessive adhesion of the aorta, the aorta and aneurysm could not be detected. We decided to remove the hematoma inside the aneurysm and perform aortic patch repair instead of total arch replacement. After cardiopulmonary bypass and deep hypothermic circulatory arrest with antegrade selective cerebral perfusion, a hall of 30mm diameter through the intimal wall was found at the aortic distal arch. The hall was a neck of the aneurysm. A dacron patch was attached to the intimal wall covering the hall after removal of the hematoma to reduce the volume of the aneurysm. After surgery, her airway was not completely relived yet owing to the remaining hematoma. Subsequently, bronchial stenting was performed. Bronchial compression was successfully resolved. She underwent tracheotomy and safely withdrew from the respirator. Aortic patch reconstruction is an alternative technique for thoracic aortic disease in the case of incapability of graft replacement or endovascular therapy. Additionally, although bronchial compression from an aortic aneurysm is not common, it could be life threatening. Endobronchial stenting is indicated not only for unresectable malignancy but also for benign lesions like an aortic aneurysm.

 

Jpn. J. Cardiovasc. Surg. 49:123-127（2020）

Keywords：thoracic aortic aneurysm;bronchial obstruction;aortic repair;bronchial stenting