[Combined acute ascending aneurysm and chronic descending thoracic aneurysms]

A 66-year-old woman with a known chronic descending thoracic dissecting aneurysm was admitted following a chest X-ray which revealed a widening in the mediastinum and an increased cardiothoracic ratio. Echocardiography and chest CT showed a combined ascending thoracic dissecting aneurysm with a tripple lumen, pericardial effision, moderate aortic regurgitation, and the chronic descending thoracic dissection with incompletely thrombosed aneurysm. The chest CT also showed a normal aortic arch. The diagnosis was then made as combined acute ascending aortic dissection (DeBakey II) and chronic descending aortic dissection (DeBakey III). A 2-stage operation was planned, involving first a graft replacement of the ascending aorta, and then one month later a graft replacement of the descending aorta.