Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 473732, 3 pages doi:10.1155/2012/473732 Case Report Giant Aortic Pseudoaneurysm with Stanford Type A Aortic Dissection after Aortic Valve Replacement Mertay Boran,1 Ali I˙hsan Parlar,2 and Ertay Boran3 1 Department of Thoracic Surgery, Cankiri State Hospital, Cankiri 18100, Turkey 2 Department of Cardiovascular Surgery, Trabzon Ahi Evren Training and Research Hospital, Trabzon 61040, Turkey 3 1st Department of Anesthesiology and Reanimation, Izmir Ataturk Training and Research Hospital, Izmir 35150, Turkey Correspondence should be addressed to Mertay Boran, mertayboran@yahoo.com Received 27 September 2011; Accepted 20 December 2011 Academic Editor: Frank A. Pigula Copyright © 2012 Mertay Boran et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Giant pseudoaneurysm of the ascending aorta is a rare but dreadful complication occurring several months or years after aortic surgery. Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture. We present a rare case of giant ascending aneurysm with Stanford type A aortic dissection occurring 6 years after aortic valve replacement and also illustrate the potential dimensions the ascending aorta may reach by a pseudoaneurysm and dissection after AVR. 1. Introduction Giant pseudoaneurysm of the ascending aorta after aortic valve replacement (AVR) is a rare and dreadful complication, which may occur several months or years after aortic surgery [1–3]. These aneurysms tend to be asymptomatic and are often diagnosed only after a complication such as dissection or rupture [3, 4]. We present a case of giant ascending pseudoaneurysm with Stanford type A aortic dissection occurring 6 years after aortic valve replacement. The case also illustrates the potential dimensions the ascending aorta may reach by a pseudoaneurysm and dissection after AVR. 2. Case Presentation A 71-year-old man, with increasing interscapular and back pain complaint that started 3 days before, was taken to emergency department after a syncope episode. He had a history of aortic valve (bileaﬂet mechanical heart valve) replacement surgery performed 6 years ago. The patient’s physical exam revealed a well-healed median sternotomy incision, 100/60 mmHg of blood pressure, 86 beats/min of heart rate, equal blood pressures in all extremities, and diminished lung sounds at the right lower hemithorax. The laboratory showed only elevated creatinin kinase levels while hemoglobin and hematocrit levels were in normal limits. Chest X-ray revealed sternal closure sutures and enlargement of mediastinum and opacities of prosthetic aortic valve (Figure 1). CT scan of the chest demonstrated an intimal ﬂap separating the true and false lumen, aneurysm of the ascend- ing thoracic aorta approximately 11 cm in diameter, large thrombus surrounding the aorta, bilateral pleural eﬀusion, more at the right (Figure 2) and minimal at the left hemitho- rax and prosthetic aortic valve (Figure 3). Transthoracic echocardiography showed a markedly enlarged ascending aorta, intimal ﬂap in the aorta, normal prosthetic valve function and 50% ventricular ejection fraction. The patient’s previous outpatient control echocardiographies performed 5 and 18 months before revealed normal prosthetic valve function and an enlarged aortic root (4.4; 4.1 cm, resp.) and ascending aorta (5.1; 5 cm resp.). Due to his stable condition, management included only pain therapy and his immediate transportation to cardiovascular surgery center in another hospital. The patient was discharged 3 days after diagnoses of giant ascending aneurysm with Stanford type A aortic dissection, because he had not accepted the emergent operation. Patient died 21 days later at his home. 3. Discussion Pseudoaneurysm of the thoracic aorta is dilatation with disruption of one or more layers of aorta’s wall. Systemic