Introduction: the aneurism of the descending aorta complicating a pseudocoa
rctation, itself due to a congenital elongation with kinking of the aorta i
s a rare entity.
Observation: we report a case of aortic aneurism discovered in a 72 years o
ld woman without notable antecedents, which was referred for recurrent bron
chitis. The X-ray showed a calcified opacity of the upper mediastinum. 5 cm
of large. A thoracic CT-scan evoked the presence of a circulating saccifor
m aneurism with calcified walls, developing on the final part of the aortic
arch, which was with abnormally ascending way going up to the cervico-thor
acic orifice and carrying out an aspect of aortic kinking.
The assessment was complemented by a RMI as well as an aortic opacification
. A thoracic scintigraphy showed an hypoperfusion of the left lung. The rem
ainder of the cardiac assessment was normal.
The patient was operated under femoro-femoral extracorporeal circulation th
rough a left posterolateral thoracotomy of the 4th intercostal space. The e
xamination showed a 7 cm diameter calcified aneurysm of the descending thor
acic aorta complicating a tight stenosis in connection with an elongation a
nd a kinking.
The upper section of the aorta was shifted towards the pleural dome. The ao
rtic section above aneurism was of normal size whereas the lower section wa
s dilated. The aneurism was excised and a prosthetic graft was carried out.
The surgery follow-up was marked by an hemodynamic stability, without neuro
logical deficit. A ventilatory assistance was necessary during 5 days. Curr
ently with 8 months follow-up, the patient goes well.
Comments: a prosthetic replacement in front of this type of aneurism is leg
itimate given the risk of the occurrence of complications secondary to the
pseudocoarctation (arterial hypertension, aortic insufficiency) or to the a
neurism itself, dissection or compression of vicinity (pulmonary artery).