A 72 year old man was referred to our hospital for surgical treatment of an aneurysm on the ascending aorta. Eleven years previously he had undergone a mechanical aortic valve replacement because of severe rheumatic aortic stenosis. The ascending aorta diameter was reported as normal at the time of aortic valve surgery and he had been doing well since then. Two months before admission to our hospital, he had experienced an episode of congestive heart failure and acute bronchitis and a computed tomographic scan of the chest revealed a dilated ascending aorta.
The patient was in New York Heart Association functional class II. Physical examination disclosed no abnormality except irregular and metallic heart sounds. Laboratory data were unremarkable. Chest radiography demonstrated slight cardiomegaly. Electrocardiography showed atrial fibrillation. Transoesophageal echocardiogram revealed normal left ventricular function, normally functioning aortic prosthesis with physiologic aortic regurgitation, mild mitral stenosis and regurgitation, and an aneurysm on the ascending aorta. Magnetic resonance imaging showed a dilatation of the ascending aorta with a sinus of Valsalva diameter of 42 mm and tubular segment diameter of 80 mm, and a large saccular aneurysm on the ascending aorta (panel A). The diagnosis was confirmed at surgery (panel B). The patient was treated by simple replacement of the supracoronary ascending aorta. Pathological findings from the resected aortic wall revealed atherosclerosis without other pathological process. The postoperative course was uneventful.