This report illustrates the lifesaving single-stage management of a ruptured pre-coarctation aortic arch in a 50-year-old female patient accompanied by a mediastinal false aneurysm.
The principles were dual right subclavian and right femoral arterial cannulation, deep hypothermia, circulatory arrest, clamping of the descending thoracic aorta (made possible after 7 minutes of circulatory arrest), resuming bypass to reperfuse the lower body by clamping the subclavian arterial cannula, removal of the false aneurysm, clamping of the supra-aortic vessels, and release of the subclavian arterial cannula clamp to reperfuse the upper body (made possible after 20 minutes of circulatory arrest), thus isolating the aortic arch while perfusing the whole body and rewarming immediately even before completing the anastomoses.
A Dacron vascular graft replaced the damaged segments of the aorta while rewarming the patient.
The operation was successful, and the postoperative course was uneventful, proving the effectiveness of the described strategy.
