Muscle Sparing Open Descending Thoracic Aortic Aneurysm Repair

The advantages of a latissimus dorsi (LD) muscle sparing thoracotomy include a reduced incidence of post-operative complications and preservation of the LD muscle for potential future reconstructive use. This case study presents the successful open repair of a descending thoracic aortic aneurysm (DTAA) performed through an LD muscle sparing thoracotomy, highlighting the technique's feasibility and clinical benefits.

A 47 year old woman was referred for management of a 5.2 cm DTAA accompanied by a heavily calcified, "coral reef" stenosis of the descending thoracic aorta in zone 4. A left LD muscle sparing thoracotomy was performed through the sixth intercostal space. Under cardiopulmonary bypass, the aneurysmal segment was reconstructed using a 28 mm inlay Dacron graft. The patient had an uneventful post-operative recovery and was discharged home on post-operative day nine.

Muscle sparing thoracotomy may confer several post-operative advantages, including reduced incisional discomfort, and a lower risk of pulmonary complications. Maintaining the integrity of the LD is particularly important, as it preserves a valuable reconstructive option should wound healing issues arise. An LD muscle sparing thoracotomy represents a safe and effective approach for open repair of descending thoracic aortic pathology, offering excellent exposure and may reduce the morbidity associated with conventional thoracic access.