Surgical Repair of an Isolated Giant Aortic Arch Aneurysm in an 11-Year-Old Girl: A Case Report

Background: Aortic arch aneurysms are exceedingly rare in children and are typically associated with connective tissue disorders, aortitis, infection, or trauma. Their management is challenging due to limited evidence guiding operative and perioperative strategies. This case describes the successful surgical repair of an isolated giant aortic arch and descending aorta aneurysm in a child, emphasizing key considerations for planning and execution. Case: An 11-year-old girl presented with a one-month history of exertional chest pain. Computed tomography (CT) revealed a 42 × 36 mm saccular aneurysm involving the distal aortic arch and proximal descending aorta, accompanied by an aberrant left subclavian artery (LSCA). Three-dimensional (3D) CT reconstruction and 3D-printed modeling facilitated operative planning. Through a left posterolateral thoracotomy and without cardiopulmonary bypass, the aneurysm was partially resected, preserving the recurrent laryngeal nerve, and the arch was reconstructed using a 14-mm Dacron graft. Cross-clamp time was 15 minutes. The patient recovered uneventfully and was discharged on postoperative day 3. Histopathology showed degeneration of the aortic wall without inflammation. Conclusions: This case highlights the importance of comprehensive preoperative imaging, individualized clamping strategy selection, and meticulous protection of adjacent structures in pediatric aortic arch aneurysm repair. These principles, consistent with approaches used for complex arch pathology, contribute to optimizing surgical safety and outcomes in this rare population.