The rupture of an azygos vein aneurysm is a very rare but catastrophic complication. Careful differential diagnosis of acute dyspnea and thoracic pain in young patients is essential for effective and early management. We present the case of a young woman with a huge, spontaneously ruptured vena azygos saccular aneurysm, successfully repaired via median sternotomy under cardiopulmonary bypass.

Objectives: Sex-related disparities are well established in cardiovascular disease, but their impact on outcomes after valve-sparing root replacement (VSRR) is not well defined. In a multicentre international cohort, we evaluated sex-based differences in clinical characteristics, radiographic features and outcomes after elective VSRR. Methods: We retrospectively analysed all patients who underwent VSRR between 2004 and 2024 at 3 high-volume centres in the United States and Europe. Baseline, operative, and imaging data were compared between sexes. The primary end-point was a composite of all-cause mortality, 30-day cerebrovascular accident, and Zone 0-3 aortic reintervention or aortic valve reintervention. Kaplan-Meier and competing risk analyses were performed, with 4:1 propensity score matching (calliper 0.2) to adjust for baseline imbalances. Results: A total of 1019 patients (191 women, 19%) undergoing VSRR were included in the study. Women were younger (46.7 vs 50.4 years, P = .002), more likely to present with heritable thoracic aortic disease (HTAD) (51% vs 17%, P < .001), and had smaller aortic diameters but larger indexed dimensions compared with men (all P ≤ .001). Aortic valve leaflet repair was performed less frequently in women (17% vs 34%, P < .001). After matching, no significant sex differences were observed in early outcomes. At 10 years, freedom from the composite end-point was similar between women and men (82.8% vs 83.9%, P = .740), as were survival (95.0% vs 96.4%, P = .920) and cumulative incidences of reintervention or dissection. Age thresholds for adverse events were lower in women (>50 years) than in men (>59 years). Conclusions: Only one-fifth of VSRR patients were women, who presented younger with more HTAD and smaller absolute aortic diameters. Despite these differences, long-term outcomes were equivalent, suggesting that sex alone does not determine surgical results. Earlier surgical referral guided by indexed aortic measurements may improve recognition and outcomes in women.

Background: We compared two different philosophies at one institution with respect to arch-geometry and clinical results: no/minimal patch vs. abundant patch augmentation. Methods: Single center retrospective analysis of the interstage angiographies of 82 patients: 41 (50%) underwent stage I Norwood-type palliation with minimal/no patch material for arch augmentation (Group 1, 2001-2011), and 41 (50%) with an abundant use of patch material (Group 2, 2011-2019). Aortic arch angle, distal arch:descending ratio, planimetry of whole arch, left hilar space were quantified. Clinical endpoints were all interstage interventions on the aortic arch, left pulmonary artery and readmissions due to left lung atelectasis and respiratory failure. Results: Arch angles were more acute in Group 1 (81°±13,2 vs. 90°±10,28, P = .012), with no difference in left hilar space (0,28±0,08 vs. 0,29±0,06, P = .43). Distal arch:descending ratio was smaller in Group 1 (0,72±0,2 vs 0,86±0,19, P = .04). Interstage interventions on the aortic arch and descending aorta were provided in 17 (41,5%) patients in Group 1 versus 19 (46,3%) patients in Group 2. Transcatheter interventions on the left pulmonary artery were necessary in 18 Group 1 patients versus 18 Group 2 patients (43,9%). Unilateral left lung atelectasis and respiratory failure occurred in 2 patients (4,4%) in Group 1 and in 3 patients (7,3%) in Group 2. Conclusions: Abundant patch material is associated with less acute aortic arch angles and leads to significantly better distal arch growth. However, this theoretical geometric benefit did not lead to greater left hilar space, nor did it prove to be superior with respect to interstage-interventions on left hilar structures. Mid-term no clinical effect was detected but future long-term effects are substantial.