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Multiple Penetrating Aortic Ulcers

Akihiko Usui, MD, Hiroshi Masumoto, MD, Toshiaki Akita, MD,


Masaharu Yoshikawa, MD, Hiroomi Murayama, MD, and Yuichi Ueda, MD
Nagoya University, Nagoya, Japan
FEATURE ARTICLES

Fig 2.

Fig 1.
Fig 3.

A 72-year-old Japanese man experienced left hemo-


thorax and mediastinal hematoma while in Swit-
zerland. He was admitted to a local hospital and was replaced with a 4-branched woven Dacron graft (He-
treated by left pleural drainage and antihypertensive mashield Gold; Boston Science, Boston, MA), and an
therapy for 1 month. He then returned to Japan and was endovascular stent graft was inserted into the upper half
admitted to our institute. Enhanced computed tomogra- of the descending aorta through the aortic arch in a
phy of his chest and 3-dimensional reconstruction re- frozen elephant trunk procedure by median sternotomy
vealed an old mediastinal hematoma and slight left [2]. The interior of the whole descending aorta was
pleural effusion. The aortic arch had a small aneurysmal observed with an endoscope. The intima was extensively
formation on the anterior wall, and the whole descending rough, with linear wrinkles, irregular erosion, and ele-
aorta showed wall irregularities and several small extru- vated atheromatous plaques (Fig 2). The patient was
sions of less than 1 cm in diameter (Fig 1). Slices through discharged from the hospital without problems 32 days
these indicated an intima defect associated with thin after surgery. He was followed up with 3-dimensional
aortic adventitia. We diagnosed these as multiple pene- computed tomography every 6 months. It revealed wall
trating aortic ulcers [1]. This represents a diffusely dis- irregularities but no apparent changes in the remaining
eased aorta and might be a cause of sealed aortic rupture. descending aorta (Fig 3). He has had no episode or
Antihypertensive medication was applied cautiously for symptom in the 2 years since the operation.
6 months, but the aortic arch aneurysm grew, and some
aortic ulcers increased in depth. We decided on surgery. References
Deep hypothermic circulatory arrest with retrograde ce-
rebral perfusion was applied after core cooling to less 1. Tittle LS, Lynch JR, Cole EP, et al. Midterm follow-up of
penetrating ulcer and intramural hematoma of the aorta.
than 20C with ascending aortic perfusion and bicaval J Thorac Cardiovasc Surg 2002;123:10519.
drainage to avoid embolization. The aortic arch was 2. Usui A, Fujimoto K, Ishiguchi T, Yoshikawa M, Akita T, Ueda
Y. Cerebrospinal dysfunction after endovascular stent-
Address correspondence to Dr Usui, Nagoya University, 65 Tsurumai, grafting via median-sternotomy (frozen elephant trunk pro-
Showa-ku, Nagoya 466-8550, Japan; e-mail: ausui@med.nagoya-u.ac.jp. cedure). Ann Thorac Surg 2002;74:S18214.

2006 by The Society of Thoracic Surgeons Ann Thorac Surg 2006;81:750 0003-4975/06/$32.00
Published by Elsevier Inc doi:10.1016/j.athoracsur.2004.01.045

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