1. Treatment of giant aortic aneurysm with tracheal compression and sternal erosion without circulatory arrest 
Roberto Lorusso, MD, PhD, Giuseppe Coletti, MD, Pasquale Totaro, MD, Roberto Maroldi, MD, Mario Zogno, MD 
The Annals of Thoracic Surgery 
Volume 69, Issue 1, Pages (January 2000)
DOI: /S (99)

2. Fig 1
Digital chest roentgenograph showing huge enlargement of the middle mediastinum on both sides, suggesting the presence of an aortic aneurysm.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

3. Fig 2
(A) Plain computed tomography study of the chest demonstrating a giant aneurym of the ascending aorta. The trachea has been posteriorly displaced with significant narrowing of the lumen. The aneurysm abuts the anterior chest wall with erosion of the posterior aspect of the sternum. (B) After bolus injection of the contrast medium, several fissurations of the thrombus are shown, projecting toward the anterior wall of the aneurysm.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

4. Fig 3
This figure shows the stepwise surgical approach used in this patient. From A to E all the progressive steps are shown. External cannulation of the right carotid artery for selective perfusion (A) and femoro–femoral cannulation for extracorporeal circulation including a double Y-junction to achieve three separate outflow lines (B) are instituted. A small anterior thoracotomy is performed to place the left ventricular vent through the apex (C) to avoid ventricular distention in the case of ventricular fibrillation caused by severe aortic insufficiency during the cooling phase. After median sternotomy, endoluminal selective perfusion of the left carotid artery (D) and occlusion of the distal aortic arch (E) are established to perform open distal anastomosis at the aortic arch while maintaining global perfusion.
The Annals of Thoracic Surgery  , DOI: ( /S (99) )