A 74-year-old man had an inflammatory pseudoaneurysm of the ascending aorta. He was admitted to a local hospital because of loss of appetite. Following intravenous hyperalimentation, he was placed under ventilatory support because of acute respiratory failure. Since his high fever and respiratory failure continued, he was transferred to our hospital. Computed tomography revealed a sealed rupture of an aneurysm in the ascending aorta. During the operation, we identified the ascending aortic aneurysm but it was very tightly attached to the surrounding wall in the perianeurysmal space. To avoid excessive hemorrhage, we closed the communication between the aneurysm and the aorta with a Dacron graft patch under deep hypothermia with circulatory arrest. He was discharged 42 days after operation without any complications. A pathological evaluation of the aneurysmal wall revealed an inflammatory pseudoaneurysm with a thick and inflammatory infiltration in the adventitia.

In a series of 20 consecutive patients from 1970 through 1988, aortic arch aneurysms were treated with the aid of selective brain perfusion. In our institute, cerebral perfusion was carried out with individual roller pumps, when the femoral artery was used for body perfusion and the innominate (INA) or right axillary artery (RAX) and left common carotid artery (LCA) were used for brain perfusion. The flow rate was 6.4±0.6ml/kg/min to the INA, 7.4±1.7 to the RAX and 5.7±1.5 to the LCA. The operative deaths were accounted in 5 cases (25%), the post operative cerebral complication was observed in 1 case (5.9%). At present we prefer to make a purse-string suture and insert the cannulas to the INA or LCA without clamping these arteries. Currently we carried out the separated brain perfusion under moderate hypothermia (26∼28°C) with indivisual roller pumps, when we maintained the flow rate to the INA or RAX constant at 7ml/kg/min, the LCA at 5.