Treatment of an aortic arch aneurysm ruptured into the lung

Shlomin V.V.¹, Drozhzhin I.G.¹, Didenko Yu.P.¹, Grebenkina N.Yu.¹, Puzdryak P.D.¹, Bondarenko P.B.¹, Pavlov D.G.², Vereshchako G.A.¹

1) Department of Vascular Surgery, Municipal Multimodality Hospital No 2,
2) Department of Radiodiagnosis, Municipal Hospital No 40, Saint Petersburg, Russia

Described herein is a clinical case report concerning treatment of a 32-year-old female patient with rupture of an aneurysm of the arch and descending portion of the thoracic aorta, with the bleeding having penetrated the upper lobe of the left lung.

The woman was admitted to the Department of Vascular Surgery of Municipal Multimodality Hospital No 2 of Saint Petersburg, presenting with a clinical pattern of aneurysmal rupture previously diagnosed by computed tomography performed at one of the local hospitals. Studying her case history revealed that, when a child, she had endured an operation for a defect of the interventricular septum and aortic coarctation with aortoplasty using a Dacron synthetic patch.

On admission, she was treated as an emergency to immediately undergo temporal ascending-descending bypass grafting of the aorta and left common carotid artery without use of a heart-lung machine. After resection of the aneurysm of the arch and descending portion of the thoracic aorta and removal of the upper lobe of the left lung, a decision was made to leave the temporal shunt as permanent. In the early postoperative period the woman developed acute cerebral circulation impairment with minimal neurological deficit which was later on relieved. After 22 days, due to persisting atelectasis of the lower lobe of the left lung, the presence of an incompetent stump of the upper bronchus and air in the left pleural cavity, as well as high risk of infection of the vascular graft, we performed final bilateral pneumonectomy with omentopexy, i.e., suturing of the greater omentum to a portion of the thoracic graft. The woman was discharged on postoperative day 34 in a satisfactory condition. She then successfully gave birth to a child. She is currently presenting neither complaints nor evidence of respiratory insufficiency. The duration of follow up amounted to 8 years.

KEY WORDS: aortic arch aneurysm, thoracic aortic aneurysm, postcoarctation aneurysm, temporal bypass graft, debranching of the aortic arch, aortic aneurysm rupture, pneumonectomy.

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