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Etiology of saccular aortic aneurysms

Department of Cardiovascular Surgery, Gazi University Medical Faculty, Ankara 06500, Turkey

Saccular ascending aorta aneurysm: report of an unusual presentation

We read with interest the paper by Borrello et al. [1] in which they presented a challenging case of saccular ascending aortic aneurysm together with its successful management. We believe the paper requires certain points to be stressed on. A naturally occurring saccular aneurysm at the ascending aorta is an extremely rare clinical entity [2]. Usually it occurs secondarily to the trauma, infection, autoimmune disorders such as Behcet's disease or other collagen vascular diseases or due to previous cardiovascular surgery [3]. We would like to discuss the points about the etiology of the patient.

From the radiographic point of view, since there was not a previous history of surgery, the pathology resembles mycotic saccular aneurysms at the ascending aorta or resulted secondary to a vasculitic syndrome [4, 5]. Are these issues considered and peri- and postoperative treatment planned accordingly? Have the authors performed a histopathologic examination of the excised aneurysm wall? In case of a mycotic aneurysm, it may not be easy to detect the organism in ordinary cultures [4, 5]; however, in highly suspected cases polymerase chain reaction (PCR) methods are highly helpful. Has this issue been considered? We believe it would be helpful for readers if authors would give more information about the etiology of their case and/or investigations performed to clarify the pathophysiology.

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1. Borrello B, Nicolini F, Beghi C, Gherli T. Saccular ascending aorta aneurysm: report of an unusual presentation. Interact CardioVasc Thorac Surg 2008;7:508–509.[Abstract/Free Full Text]
2. Ting AC, Cheng SW, Ho P, Poon JT. Endovascular repair for multiple Salmonella mycotic aneurysms of the thoracic aorta presenting with Cardiovocal syndrome. Eur J Cardiothorac Surg 2004;26:221–224.[Abstract/Free Full Text]
3. Tochii M, Ando M, Takagi Y, Yamashita M, Hattori K, Hoshino R, Akita K. Saccular true aneurysm of the ascending aorta 19 years after aortic cannulation: report of a case. Surg Today 2007;37:893–896; Epub 2007 Sep 26.[CrossRef][Medline]
4. Ugurlucan M, Alpagut U. Endoluminal stenting of thoracic aorta mycotic aneurysms. Eur J Cardiothorac Surg 2007;32:945–946; author reply 946-947. Epub 2007.[Free Full Text]
5. Alpagut U, Ugurlucan M, Kafali E, Surmen B, Sayin OA, Guven K, Dayioglu E, Rozanes I, Onursal E. Endoluminal stenting of mycotic saccular aneurysm at the aortic arch. Tex Heart Inst J 2006;33:371–375.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Dilek Erer Erkan Iriz Veli Yildirim Imren Permission Requests Google Scholar Articles by Erer, D. Articles by Imren, V. Y. PubMed Articles by Erer, D. Articles by Imren, V. Y. Related Collections Related Article