[Newly designed approach to an aneurysm eroding the sternum and protruding over the sternum]

A 54-year old man was admitted with a complaint of a pulsating tumor (7 x 6 x 2 cm) above the sternum accompanied by dysphagia. DSA showed the pulsating tumor was an aneurysm arising from the ascending aorta. CT gram of the sternum showed that the sternum was destroyed partially at the level of the 1st rib. We did the Y shaped skin incision. The clavicles, 1st and 2nd ribs were dissected out periosteally and perichondrially. We cut the clavicles and ribs, and dissected the mediastinum median to the internal mammary artery. Under the perfusion, F-F bypass and brain perfusion, the upper half of the sternum was dissected safely from the aneurysm. The aneurysm was false aneurysm and the perforating ostium was 3.5 cm in diameter. The margin of the perforating ostium had a deposit of calcium. Using an occlusion balloon catheter from the ostium, patch closure was done. The postoperative course was uneventful. We believe that this new approach is preferable to the severe erosion of the sternum by the aneurysm.