To present a case of a 71 year-old male with fusiform aneurysm of the ascending aorta who developed dissection of the aortic arch up to the descending aorta intraoperatively.

Patient is a 71-year old, male, hypertensive, dyslipidemic, non-diabetic with a 2-year history of chest pain, burning sensation, relieved by rest. On routine follow up, 2D echo noted aneurysmally dilated aortic root. CT Angiogram of Thoracic and Abdominal Aorta showed fusiform dilatation of the ascending aorta, maximum diameter of 5.0 cm, length of 7.0 cm. No signs of rupture or intramural hematoma. Other laboratory work-ups were unremarkable. Patient was referred to Interventional Cardiology and Thoracic-Cardiovascular Surgery Service and advised open surgical repair. Patient underwent elective open surgical repair of the ascending aortic aneurysm. Preoperative transesophageal echocardiogram showed dilated ascending aorta with widest diameter of 6cm. Intraoperative findings showed fusiform dilatation of the ascending aorta, maximum diameter of 6cm, length of 7.0cm. No signs of rupture or intramural hematoma. The repair of the ascending aortic aneurysm was unremarkable, however, midprocedure transesophageal echocardiography showed dissection at the descending artery extending to aortic arch common carotid arteries and up to descending aorta with no note of entry and exit points.

The surgical team proceeded with replacement of aortic hemiarch and total arch debranching. Rewarming was commenced. Patient was then transferred to cardiovascular recovery room and eventually to coronary critical care unit for continuity of care. Patient did not develop any signs of cerebral hypoperfusion, kidney injury and peripheral malperfusion. Patient was subsequently discharged, recovered.

Complications are always unwelcome and unwanted, but sometimes cannot really be prevented. Aortic arch aneurysms is relatively uncommon and may lead to catastrophic events if not adequately managed. Urgent decision making, appropriate pre-operative preparation are both crucial to achieve a successful outcome. Also, patient's good compliance to medications, follow-up and cardiac rehabilitation, contributed to immediate recovery.