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- Received March 19, 2010
- Accepted April 1, 2010
- Published online March 15, 2011.
A 77-year-old woman underwent coronary artery bypass grafting in 2002. The surgeon noted a mass on the ascending aorta, adjacent to the innominate artery. He performed an off-pump coronary artery bypass grafting procedure to avoid manipulation of the aorta. The patient subsequently experienced 2 documented cerebral embolic events. The most recent resulted in a permanent bilateral visual field defect. Serial computed tomographic studies demonstrated progressive enlargement of a penetrating atherosclerotic ulcer of the ascending aorta adjacent to the origin of the innominate artery (A, arrow). The patient underwent excision of the penetrating ulcer (B, arrow), the ascending aorta, and the aortic arch to the level between the origins of the left carotid and innominate arteries. The ascending aorta and innominate artery were replaced with prosthetic grafts. Penetrating atherosclerotic ulcers are commonly found in the descending but rarely in the ascending thoracic aorta. Embolization from the ulcer crater was the likely cause of the cerebral embolic events.
- Received March 19, 2010.
- Accepted April 1, 2010.
- American College of Cardiology Foundation