Management of intact giant fusiform aneurysm of distal aortic arch with impeding risk of rupture using midline sternotomy

Aneurysm of the distal aortic arch is routinely repaired using left thoracotomy. Here, we are reporting an unusual case of intact giant fusiform aneurysm of the distal aortic arch with managed successfully using midline sternotomy. A 54-year-old gentleman presented with progressive dyspnea and chest pain in the New York Heart Association Class IV. He was diagnosed to have intact giant (11 cm × 11.5 cm × 12 cm) fusiform aneurysm of the distal aortic arch extending up to proximal descending thoracic aorta resulting in the displacement of trachea toward the right and left main bronchus inferiorly with underlying lung collapsed. The patient underwent distal arch replacement through midline sternotomy under deep hypothermic circulatory arrest with continuous selective antegrade cerebral perfusion using the right axillary artery and right femoral artery cannulation. The arch was replaced using 28-mm collagen impregnated, woven polyester graft. He remained stable postoperatively and was discharged on the 10th postoperative day.