A 73-year-old woman with a history of hypertension presented to a hospital of origin with sudden onset pain, scored 10 on the analogical numerical scale (with a value of 10 on the analogical numerical scale), with three days of evolution.
Electrocardiogram (ECG) and cardiac enzymes were requested, which were within normal ranges, so outpatient treatment with analgesics was decided.
Two days later, the patient consulted again in the emergency room due to persistent pain, ECG showed ST-segment elevation in the inferior wall and elevated cardiac enzymes.
Acute myocardial infarction (AMI) was diagnosed and evaluated by Cardiology, who did not thrombolyze for the time of evolution.
Due to persistent symptoms and hypertensive emergency, a chest X-ray and computed tomography angiography (Angio-TC) were requested, which showed acute hemopericardium bleeding of AA secondary to parietal ulcer.
Due to the findings, the patient was classified as AAS and referred to our center for surgical resolution.
The patient was admitted that same day without hemodynamic deterioration, transesophageal echocardiography showed findings similar to those described in CT angiography, so the cardiosurgical team decided emergency surgery.
Endoscopic surgery was performed with cardiopulmonary bypass (CPB) replacement of AA with GelwareTM#28 prosthesis.
Intraoperatively, a tension hemopericardium of approximately 300 cc was observed, an ascending aortic hematoma that did not involve the aortic arch, a penetrating ulcer with contained rupture, without observing aortic dissection.
The patient presented atrial fibrillation, which reverted with the use of amiodarone.
She was discharged ten days after surgery.
Pathology confirmed UPAA and adenocarcinoma.
Currently, after one year of follow-up, the patient continues her controls without presenting cardiovascular symptoms.
