A surgical approach to aortic arch aneurysms presenting through the sternum

A surgical approach to the repair of aortic arch aneurysm presenting through the sternum is described. A limited right anterior thoracotomy is made to gain access to the right and left atria. A vertical sternotomy is made only after profound core hypothermia has been achieved and the fibrillating left ventricle decompressed. The circulation is arrested and the patient exsanguinated during sternotomy, providing controlled conditions should the aneurysm be entered.