A 68-year-old male, former smoker, hypertensive, dyslipidemic and with a history of colon neoplasia operated 5 years ago.
A routine CT scan of the abdominal aorta revealed thickening of the left side of the ascending aortic wall with several ulcers greater than 1.8 x 0.9 cm, located in the ascending lateral aortic wall.
Similarly, a 4.8 cm long mural hematoma is observed next to the ulcer.
Although the patient does not report symptoms, the images are compatible with UPAA indicating replacement surgery of the ascending aorta.
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Under general anesthesia, a medial anastomosis is performed.
Median implantation of two cannulas -arterial and venous- in femoral artery and right atrial appendage, respectively, was established extracorporeal circulation.
The aorta was clamped, the heart was clamped with a dose of anterograde cardioplegia and a longitudinal anastomosis was performed.
Once opened, an ulcer on the face - left of the ascending aorta is observed, at one centimeter of the brachiocephalic arterial trunk, as well as a circumferential aortic dissection ulcer on the corresponding aortic segment.
It was decided to perform deep hypothermia (17oC) and circulatory arrest to resect the segment of aorta containing the rupture and extending to the brachiocephalic trunk.
During the 21-minute circulatory arrest, retrograde cerebral perfusion was performed through a cannula placed in the superior vena cava.
The ascending portion of the aorta is replaced by a 3.4 cm vascular prosthesis.
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The postoperative period was uneventful and the patient was discharged on the eighth day.
Ten months after the operation, the patient is alive and without complications.
