Leivaditis Vasileios, Papatriantafyllou Athanasios, Milas Theodoros, Baikoussis Nikolaos G
Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU.
Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, GRC.
Cureus. 2025 Jul 25;17(7):e88717. doi: 10.7759/cureus.88717. eCollection 2025 Jul.
Giant aortic root aneurysms are rare and potentially life-threatening, especially when the diameter exceeds 10 cm. These cases require urgent surgical intervention and pose significant technical challenges due to the risk of rupture, distorted anatomy, and associated valve dysfunction. We report the case of a 58-year-old man who presented with acute chest pain and refractory hypertension. Transthoracic echocardiography revealed severe aortic regurgitation, a dilated left ventricle with an ejection fraction below 30%, and an aortic root estimated at over 11 cm. CT angiography confirmed a giant aortic root aneurysm without dissection. Given the imminent risk of rupture, the patient underwent emergent open surgical repair. Axillary artery cannulation and early heparinization were performed to minimize intraoperative risk. Heparin was administered after axillary artery cannulation and before sternotomy to enable immediate initiation of cardiopulmonary bypass in case of rupture. A standard Bentall procedure using a 27 mm mechanical valved conduit and 30 mm Valsalva graft was successfully completed. The postoperative course was uneventful, and follow-up at three and nine months showed excellent clinical recovery and graft function. This case underlines the importance of early recognition and timely surgical intervention in giant aortic root aneurysms. Although the Bentall procedure is routinely performed worldwide, the surgical management of giant aneurysms >10 cm remains technically complex and underreported. Preoperative planning, alternative cannulation strategies, and meticulous surgical technique are crucial for safe and effective management of these high-risk cases.
巨大主动脉根部动脉瘤较为罕见且有潜在生命危险，尤其是当直径超过10厘米时。这些病例需要紧急手术干预，并且由于破裂风险、解剖结构扭曲以及相关瓣膜功能障碍，会带来重大技术挑战。我们报告一例58岁男性患者，其表现为急性胸痛和难治性高血压。经胸超声心动图显示严重主动脉瓣反流、左心室扩张且射血分数低于30%，主动脉根部估计超过11厘米。CT血管造影证实为无夹层的巨大主动脉根部动脉瘤。鉴于即将破裂的风险，患者接受了紧急开放手术修复。进行腋动脉插管和早期肝素化以将术中风险降至最低。在腋动脉插管后且在胸骨切开术前给予肝素，以便在破裂时能立即启动体外循环。使用27毫米带机械瓣膜的管道和30毫米瓦氏窦移植物成功完成了标准的Bentall手术。术后病程平稳，术后三个月和九个月的随访显示临床恢复良好且移植物功能正常。该病例强调了早期识别和及时手术干预巨大主动脉根部动脉瘤的重要性。尽管Bentall手术在全球范围内常规开展，但直径>10厘米的巨大动脉瘤的手术管理在技术上仍然复杂且报道较少。术前规划、替代插管策略以及细致的手术技术对于安全有效地管理这些高危病例至关重要。
