Asymptomatic giant ascending aortic aneurysm: a challenging surgical strategy for a silent bicuspid aortopathy

Submitted: January 29, 2024
Accepted: March 12, 2024
Published: March 18, 2024
Abstract Views: 218
PDF_EARLY VIEW: 101
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

We report the case of an incidental finding of a huge aneurysm of the ascending aorta with a congenital bicuspid aortic valve type 0-lateral. This severe condition was totally unknown to the patient, who was asymptomatic for cardiovascular disease. The aneurysmal mass involved the entire mediastinum, altering the normal anatomical relations, so the operative strategy was modified intraoperatively, tailoring the surgical technique to the anatomical conditions found. Despite a delayed awakening, the patient had an uncomplicated postoperative course. Therefore, this case highlights the importance of not underestimating nonspecific, seemingly harmless symptoms and signs that may reveal potentially catastrophic pathologies, while also focusing on the surgical technique used. The modified Cabrol procedure, while an underutilized technique, if present in the cardiac surgeon's "arsenal," can represent a life-saving strategy in complex cases requiring an aortic valve and ascending aorta replacement.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Shah P, Gupta N, Goldfarb I, Shamoon F. Giant dissecting aortic aneurysm in an asymptomatic young male. Case Rep Vasc Med 2015;2015:958464. DOI: https://doi.org/10.1155/2015/958464
Yamashita T, Hayashi T, Tabata T, at all. Bicuspid aortic valve-associated aortic dilatation - what is the mechanism of bicuspid aortopathy?. Circ J 25;82:2470-1. DOI: https://doi.org/10.1253/circj.CJ-18-0844
Michelena HI, Della Corte A, Evangelista A, et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg 2021;162:e383-e414. DOI: https://doi.org/10.1016/j.jtcvs.2021.06.019
Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. Circulation 2022;146:e334-e482. DOI: https://doi.org/10.1161/CIR.0000000000001097
Di Michele S, Parato VM, Di Giannuario G, et al. Unlocking insights in bicuspid aortic valve management in adult patients: the vital role of cardiac imaging. Monaldi Arch Chest Dis 2023;94(1). DOI: https://doi.org/10.4081/monaldi.2023.2761
Okura T, Kitami Y, Takata Y, et al. Giant unruptured aneurysm of the thoracic aorta-a case report. Angiology 1999;50:865-9. DOI: https://doi.org/10.1177/000331979905001012
Pape LA, Tsai TT, Isselbacher EM, et al. Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2007;116:1120-7. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.702720
Mossuto E, Milano A, Bortolotti U. The Cabrol technique for replacement of the aortic valve and totally calcified ascending aorta: a case report. J Heart Valve Dis 1994;3:98-100.
Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007;133:1226-33. DOI: https://doi.org/10.1016/j.jtcvs.2007.01.039

How to Cite

Romeo, Maria Grazia, Emanuele Pilato, Raffaele Giordano, Giuseppe Comentale, Gabriele Iannelli, Domenico Romeo, Bruna Miserrafiti, and Luigi Di Tommaso. 2024. “Asymptomatic Giant Ascending Aortic Aneurysm: A Challenging Surgical Strategy for a Silent Bicuspid Aortopathy”. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2024.2936.