Recurrent Syncope in a Patient with Thoracic Aortic Aneurysm

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We report a case of a 79-year-old male patient with syncope. The thoracic aortic aneurysm (TAA) which size was 4.6/6.0 mm, was pointed out in 1997. Episodes of syncopal attack associated with walking and urinating were developed in 2005. Neurally mediated syncope (NMS) was suggested because magnetic resonance imaging of head and neck, echocardiography and electrocardiogram showed no abnormal findings. Permanent pacemaker was implanted for uncontrollable cardioinhibitory type of NMS in 2006. However, syncopal attack was reccured during the meal one month later after pacemaker implantation. Ventricular pacing rhythm with low blood pressure was observed on admission, so diagnosed as mixed type of NMS. At that time, the size of TAA was enlarged (7.2/8.4 mm), and total arch replacement surgery was performed. The syncopal attack had disappeared for five years after surgery. <B>Conclusions:</B> Total arch replacement surgery was feasible in a patient with vasovagal reflex-mediated syncope. This syncope might be associated with mechanical compression of the baroreceptor of aortic wall by TAA.
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