Floating mass in the aortic arch: An interesting case report

Area of Science:

• Cardiovascular Surgery
• Diagnostic Imaging
• Vascular Medicine

Background:

• Floating masses in the aortic arch are uncommon, with controversial management strategies.
• Atherosclerotic plaques are typically visualized using computed tomography (CT) scanning.
• Suprasternal transthoracic echocardiography can serve as an effective screening tool for aortic arch atheromas.

Purpose of the Study:

• To report a case of a ruptured floating atheromatous aortic plaque in a patient with severe aortic valve stenosis and coronary artery disease.
• To discuss the management challenges and surgical approach for combined aortic valve stenosis and aortic plaque.
• To underscore the diagnostic utility of suprasternal echocardiography in identifying pedunculated aortic arch masses.

Main Methods:

• A 77-year-old male patient with dyspnea underwent diagnostic imaging.
• Computed tomography scanning and suprasternal echocardiography were utilized for visualization.
• Surgical intervention involved simultaneous atheromatous plaque removal and aortic valve replacement.

Main Results:

• A ruptured floating atheromatous aortic plaque was identified.
• The patient presented with severe aortic valve stenosis and coronary artery disease.
• Successful simultaneous surgical removal of the plaque and aortic valve replacement were performed.

Conclusions:

• Management of combined aortic valve stenosis and pedunculated aortic plaque requires careful consideration.
• Atheromatous plaque removal prior to aortic valve replacement is crucial to prevent embolic events.
• Suprasternal echocardiographic views are vital for diagnosing pedunculated masses in the aortic arch.