[Spontaneous rupture of the ascending aorta--a case report of successfully treated by surgery]

We experienced a case of spontaneous rupture of the ascending aorta, which seems to be the second case reported in the Japanese literature. A 64-year-old man was admitted to our hospital because of severe anterior chest pain and collapse. Dilatation of the ascending aorta associated with pericardial effusion was demonstrated on CT and echocardiography. There was, however, no evidence of intimal flap in the aorta. Emergency pericardiocentesis was done for cardiac tamponade which developed in spite of aggressive hypotensive therapy. But, persistent tamponade necessitated median sternotomy, and then, it was found that left lateral aspect of the ascending aorta was covered with fresh blood clot. Inspection from inside of the aorta after aortotomy under cardiopulmonary bypass revealed a small transmural perforation at the left side of the aorta at approximately 15 mm distal to the aortic anulus. The perforated wall was directly closed with a running 4-0 polypropylene suture, and the aortic root was wrapped around with a sheet of Teflon felt. Postoperative course was uneventful. When acute intrapericardial or intrapleural bleeding develops with no evidence of aortic aneurysm or dissection, presence of spontaneous aortic rupture should be taken into consideration, although it happens very rarely.