Distal arch aneurysm and acute aortic dissection with bicuspid aortic valve; report of a case

A 49-year-old man was admitted to our institution with acute chest and back pain. Chest and abdominal computed tomography (CT) showed type A aortic dissection from the ascending aorta to the bilateral common iliac arteries and a distal arch aneurysm with a diameter of 65 mm. Echocardiogram showed a bicuspid aortic valve with severe regurgitation. We performed total arch replacement and aortic valve replacement. Pathological examination of the aortic wall revealed a typical cystic medial necrosis. After 3 months, we performed the 2nd stage operation for the distal arch aneurysm and descending aortic dissection. Here, we report a rare case of bileaflet aortic valve with aortic aneurysm and aortic dissection.