[A simple surgical method for removing a large floating thrombus from the ascending aorta]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Diagnostic Imaging

Background:

• Systemic embolization poses a significant risk, often originating from aortic sources.
• Large free-floating thrombi in the ascending aorta are rare but critical embolic events.
• Accurate diagnosis and timely intervention are crucial for patient outcomes.

Observation:

• A large, free-floating thrombus was identified in the ascending aorta, distal to the left coronary sinus.
• The thrombus was associated with a ruptured atherosclerotic plaque, indicating a high embolic potential.
• Multiple advanced imaging modalities including TEE, CT, aortography, and CMR were used for diagnosis.

Findings:

• Successful surgical excision of the large aortic thrombus was achieved using a straightforward surgical approach.
• The procedure involved isolated cerebral perfusion with circulatory arrest under normothermia, ensuring safe access.
• The patient experienced an uneventful recovery and was discharged on postoperative day 7.

Implications:

• This case demonstrates the feasibility and safety of surgical thrombus removal from the ascending aorta.
• Advanced imaging plays a vital role in diagnosing and characterizing complex aortic pathologies.
• Effective surgical management can lead to complete recovery in patients with life-threatening embolic events.