case_images: PMC8728859_01
case_images: Preoperative computed tomography demonstrates a 6.5 cm arch aneurysm, extending from the origin of the innominate artery to the origin of the left subclavian artery.
case_images: JTHC-16-38-g001.jpg
case_images: PMC8728859_01_JTHC-16-38-g001.jpg
case_images: F1
case_images: Transthoracic echocardiography illustrated diastolic dysfunction, a mildly dilated left atrium, mild mitral and tricuspid regurgitation, a normal aortic valve, a hypertrophic interventricular septum, and a dilated aortic arch (53 mm) (Figure 1).
case_images: Postoperative computed tomography volume-rendering reconstruction demonstrates the position of the stent-graft and the patency of the debranching graft.
case_images: JTHC-16-38-g002.jpg
case_images: PMC8728859_01_JTHC-16-38-g002.jpg
case_images: F2
case_images: A radiopaque marker was implanted around the aorta, 2 to 3 cm proximal to the aneurysm, as a guide for the retrograde implantation of the stent-graft (Cook Medical) into the aortic arch and the proximal descending aorta (Figure 2).
case_images: Computed tomography demonstrates the dissection, involving the ascending aorta and extending toward the left coronary sinus.
case_images: JTHC-16-38-g003.jpg
case_images: PMC8728859_01_JTHC-16-38-g003.jpg
case_images: F3
case_images: Computed tomography angiography showed dissection of the ascending aorta originating from the proximal edge of the previously inserted stent-graft and extending toward the left coronary sinus (Figure 3).
case_images: The image presents an intraoperative view, with the blue arrow pointing to the Dacron graft of the ascending aorta and the green arrow pointing to the cannula for the selective cerebral perfusion of the debranching graft.
case_images: JTHC-16-38-g004.jpg
case_images: PMC8728859_01_JTHC-16-38-g004.jpg
case_images: F4
case_images: Next, the ascending aorta was transected, and the Bentall procedure was performed (Figure 4) with a 25 mm composite graft.