Treatment of a giant ascending aortic pseudoaneurysm presenting as a presternal pulsatile protrusion almost perforating through the skin.

Aortic pseudoaneurysms have the potential for eroding bony structures in the chest, including the sternum, over time. Here, we report the case of a 54-year old woman with a giant pseudoaneurysm of the ascending aorta, 19 years after aortic root (mechanical conduit) and hemiarch replacement. The patient presented to her primary-care physician with a pulsatile presternal subcutaneous protrusion in the midline of her median sternotomy scar. We performed a challenging midline resternotomy after the establishment of a surgical safety net for cerebral and visceral organ protection followed by a supracoronary ascending and hemiarch replacement including a reinsertion of the coronary ostia employing selective antegrade cerebral perfusion and mild systemic hypothermic circulatory arrest. We discuss here the specific surgical considerations of this case.