Intrapericardial rupture of distal aortic arch aneurysm.

Intrapericardial rupture of an aortic arch aneurysm is a rare and catastrophic event that requires emergency treatment. Recent development of thoracic endovascular repair has contributed to improved outcomes for the treatment of ruptured aneurysm of the thoracic aorta. However, when there is an aneurysm that involves the arch vessels, the treatment strategy, including conventional open surgery and endovascular stenting, is still controversial. We performed life-saving emergency total arch replacement using a modified elephant-trunk procedure for two cases of intrapericardial rupture of an aortic arch aneurysm. Prompt institution of cardiopulmonary bypass is effective for reducing the risk of re-rupture. Hybrid operation caries the risk of re-rupture during the procedure because it is performed under heparinization without blood pressure control. Open surgery is still a good option for such cases.