Pinhole rupture of aortic root aneurysm with severe atherosclerotic change.

We report two cases of the rupture of calcified aortic root aneurysms that were successfully treated by emergency operations. One patient underwent Bentall's operation, and for the other, we performed a valve-sparing operation. Because their aneurysms revealed pear-like configurations with aortic regurgitation, the findings were consistent with annuloaortic ectasia (AAE). However, both cases were unlike typical AAE in that the aortic walls showed severe atherosclerotic change, with little sign of cystic medial necrosis. It was very interesting that each rupture point was a very small pinhole originating from one of the atherosclerotic ulcers.