[Successful treatment of ruptured descending thoracic aortic aneurysm associated with right tension hemothorax during operation].

ABSTRACT

A 59-year-old man was admitted to the hospital, suspected of the rupture of descending thoracic aortic aneurysm due to sudden back pain. Enhanced computed tomography revealed a ruptured descending thoracic aortic aneurysm with huge hematoma and abdominal aortic aneurysm. Based on the above diagnosis, we performed urgent operation through left thoracotomy under unilateral lung ventilation. While dissecting the aneurysm, sudden hemodynamics deterioration occurred. Although cardiopulmonary bypass was introduced immediately through femoral artery and femoral vein cannulations, hemodynamics was not improved and unilateral lung ventilation got more unmanageable. We diagnosed right tension hemothorax due to the extension of aneurysm rupture into the right thoracic cavity. After placing a cannula at the distal arch for a central perfusion, we clamped the descending thoracic aorta at both the proximal and distal sites of the aneurysm. Thereafter we opened the aneurysm and drained the right thorax through the aneursym's tear. The aneurysm was replaced with a prosthetic woven-Dacron vascular graft. The patient's postoperative condition had been stable with no significant unfavorable event. The abdominal aortic aneurysm was replaced with a bifurcated graft on 51st postoperative day. He was discharged in good condition on the 69th postoperative day.