A Giant Ascending Aortic Aneurysm in a 12-Year-Old Female: A Case Report

Ascending aortic aneurysms are uncommon, heart diseases typically associated with advancing age; in children and young adults, they are rare and predominantly linked to connective tissue disorders, such as Marfan syndrome, or congenital heart defects.

We present an incidental finding of a giant ascending aortic aneurysm with severe aortic regurgitation in a 12-year-old female. The patient initially presented to the paediatric outpatient department three years prior to index presentation with dyspnoea and palpitations on exertion but was lost to follow-up before a definitive diagnosis was established. She returned with rapidly worsening symptoms over 10 days, presenting with heart failure. She had a Marfanoid phenotype. Transthoracic Doppler echocardiography imaging revealed a significant pericardial effusion, a huge (7.8 cm) ascending aortic aneurysm, severe aortic regurgitation, and a small peri-membranous ventricular septal defect (VSD). She successfully underwent a modified Bentall procedure with a 21 mm composite On-X graft and VSD closure, with an unremarkable post-operative recovery. While valve-sparing root replacement is often advocated to avoid anticoagulation.

This case illustrates that advocacy should not supersede the necessity for durable surgery. In settings where out-of-pocket healthcare costs are high, prioritizing a mechanical valved conduit is essential to minimize the risk of reoperation.