A widened mediastinum in an asymptomatic man with a remote history of repaired type-A aortic dissection.

Fig 2. Axial computed tomography scan with angiographic contrast obtained at the level of the aortic arch. A64-YEAR-OLD, 86-kg, 183-cm man with prostate cancer was evaluated in the authors’ preoperative assessment clinic before a scheduled prostatectomy. He denied cardiac symptoms and described only mild shortness of breath with heavy exertion. His past medical history was notable for an acute type-A aortic dissection that occurred 14 years before the current evaluation. The medical records were obtained from a local community hospital where the patient had received care. According to the operative report, the intimal tear of the dissection was located in the mid-ascending thoracic aorta. The dissection extended retrograde into the sinuses of Valsalva, coronary ostia, and aortic valve annulus; proceeded antegrade into the iliac arteries; involved the innominate and right carotid arteries; and was associated with severe aortic valve insufficiency. During surgery, the native aortic valve was deemed to be unsalvageable and was excised; a 25-mm bileaflet mechanical prosthesis was implanted. The ascending thoracic aorta was replaced with a 28-mm woven Dacron graft (Hemashield, Maquet Cardiovascular, Wayne, NJ), and the coronary arteries were reimplanted. The aortic arch was not addressed. The patient made an uneventful recovery without neurologic or