Management
The patient was tachycardic and was started on low dose esmolol drip.
Midline sternotomy was performed which revealed that the heart and
mediastinum were encased in clot and bulging pericardium which was
removed with pericardiotomy. Direct visual examination revealed an
intact aortic arch with rupture at the sino-tubular ridge extending to
the left coronary ostium. The entire posterior aspect of the ascending
aorta was transected with complete separation of the adventitia, media
and intima with dissecting aneurysm and contained periaortic hematoma
formation. Left coronary ostium was repaired, 23 mm valved St. Jude
conduit was placed, ascending aorta was repaired and both coronary
arteries were re-implanted. Intraoperative TEE post-Bentall procedure
revealed a competent aortic valve and good flow in the coronary
arteries. The patient was discharged home with uneventful postoperative
stay.