case_images: PMC10012987_01
case_images: (a) Aneurysm of the ascending aorta is observed on preoperative CTA and (b) its three-dimensional recon- struction.
  CTA: Computed tomographic angiography
case_images: TJTCS-2023-31-1-123-127-F1.jpg
case_images: PMC10012987_01_TJTCS-2023-31-1-123-127-F1.jpg
case_images: F1
case_images: The ascending aortic aneurysm was confirmed by a computed tomographic angiography (CTA) scan and the maximum diameter was measured 50 mm in the ascending aorta and 35 mm in the aortic arch (Figure 1).
case_images: (a) The descending aortic aneurysm is observed on CTA performed before the first operation. (b) The image of the repairing the previous descending aortic aneurysm with the tube graft interposition.
  CTA: Computed tomographic angiography.
case_images: TJTCS-2023-31-1-123-127-F2.jpg
case_images: PMC10012987_01_TJTCS-2023-31-1-123-127-F2.jpg
case_images: F2
case_images: A tube graft with a diameter of 22 mm from the previous operation was observed in the descending thoracic aorta (Figure 2).
case_images: (a) The arrow shows the dilated, thickened and diffusely infiltrated aortic wall. (b) The image of suturing the left main coronary button to the graft with a fenestrated Teflon  patch support. (c) The image of suturing the distal anastomosis of the graft proximal to the aortic arch. (d) CTA scan of the patient with three-dimensional reconstruction at the postoperative third month.
  LMCA: Left main coronary artery; RCA: Right coronary artery; CTA: Computed tomographic angiography.
case_images: TJTCS-2023-31-1-123-127-F3.jpg
case_images: PMC10012987_01_TJTCS-2023-31-1-123-127-F3.jpg
case_images: F3
case_images: The aortic valve was tree leaflet, the leaflets were very thin, elongated, and the inflammation of the aortic wall extended to the aortic root (Figure 3a).  Teflon  patch support (Figure 3b). The distal anastomosis of the graft was done under total circulatory arrest at the level of the truncus brachiocephalicus ostium proximal to the aortic arch (Figure 3c). The period of total circulatory arrest was 17 min, aortic cross-clamping was 60 min, and CPB was 161 min.  After a follow-up of four months, he is currently in a good clinical condition (Figure 3d).