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Ascending aortic replacement through right thoracotomy
Naotaka Motoyoshi1, Katsuhiko Oda, Yusuke Tsuru
1Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan. paq@mva.biglobe.ne.jp
Summary
A novel right thoracotomy approach enabled successful ascending aortic aneurysm repair in a patient with a prior esophageal surgery. This technique safely accessed the aorta, bypassing the limitations of a standard median sternotomy.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Aneurysm Repair
Background:
- A 62-year-old female patient with a history of esophageal resection and colon interposition presented with a dissecting aortic aneurysm.
- Conventional median sternotomy was precluded by a pre-existing anterosternal subcutaneous tunnel from the previous surgery.
Observation:
- Preoperative three-dimensional computed tomography (3D CT) was utilized to assess the feasibility of alternative surgical approaches.
- The imaging suggested that a right thoracotomy could provide adequate exposure for ascending aortic surgery.
Findings:
- The patient successfully underwent ascending aortic replacement using a right anterolateral thoracotomy approach.
- The procedure was performed under hypothermic circulatory arrest, ensuring patient safety.
- This approach provided safe and effective exposure of the ascending aorta, overcoming the anatomical challenges.
Implications:
- Right thoracotomy represents a viable alternative for ascending aortic surgery in patients with complex prior sternotomies or bypass grafts.
- This technique expands surgical options for aortic aneurysm repair in challenging anatomies.
- It highlights the importance of advanced imaging in surgical planning for complex cardiovascular cases.