Aneurysm and dissection of the ascending aorta were initially treated with replacement of the ascending aorta and repair of the dissection with Dacron graft (30 mm) in another cardiac center.
4 months later the patient presented with fever, shortness of breath, and diarrhea. Septic workup including blood culture was negative. Transthoracic echocardiography (TTE) did not show any vegetation, thrombus, or prosthetic valve dysfunction; however, dehiscence was found between the proximal end of the graft and the native aortic root tissue at the sino-tubular junction (STJ) anteriorly on transesophageal echocardiography(TEE) which was compatible with CT scan findings of an endoleak (type 1a). The patient was initially managed conservatively; however, follow-up echocardiograms and CT chest showed persistent peri-aortic fluid collection, an increase in the size of the endoleak, and development of aortic root aneurysm measuring 5 cm. 2 months later, finally, he underwent a Bentall procedure.
Currently, the patient is doing fine and is under regular follow-up with cardiology.
Aneurysm and dissection of the ascending aorta, in this case, were likely complications, related to the patient's history of the bicuspid aortic valve.