Intra-Operative Rupture of Giant Ascending Aorta and Aortic Arch Aneurysm In Open Heart Surgery: A Successful Peri-operative Management

Introduction: Giant thoracic aortic aneurysms are rare. Most of the reported cases are not a known complication of aortic coarctation repair. Otherwise intra-operative aneurysm ruptures are rare cases but a potentially fatal complication in open heart surgery. Case report: In this article, we report the case of a 23-year-old patient with a giant ascending and arch aneurysm associated with a Standford type A chronic aortic dissection. In the patient’s history a coarctation repair at age of five years old was noted. During an open heart surgery for ascending aorta and hemi-arch replacement under cardiopulmonary bypass, aneurysm rupture occurred before aortic cross-clamp. A successful intraoperative and post-operative management was performed. The course was uneventful. The patient was extubated without neurological damage. Moreover, there were no kidney function deterioration, no digestive and limbs ischemia. Conclusion: Intra-operative aneurysm rupture is rare but is a major operative complication whose successful repair depends on an integrated intra-operative management. Cerebrovascular and heart protection are the main determinants of patient survival. Also, the surgical team’s prompt response is the key to the successful execution of the procedure.