title: Endarterectomy and graft replacement of severely calcified (porcelain) ascending aorta with coronary ostial involvement in a patient requiring aortic valve replacement.
abstract: We report a successful aortic valve replacement within an extensively calcified (porcelain) aorta, involving the left coronary artery ostium. Clamping such an aorta can result in embolization, dissection, and mural laceration. A 72-year-old female presented with a severely calcified and stenotic aortic valve with a peak pressure gradient of 101 mmHg. Computed tomography demonstrated extensive calcification of the ascending aorta. Coronary angiogram showed a 50% ostial left coronary artery stenosis. Under deep hypothermic circulatory arrest, the aorta was transected at the proximal arch and distal graft anastomosis was performed. This was followed by endarterectomy of the porcelain ascending aorta and the left coronary ostium. Aortic valve replacement, proximal aortic graft anastomosis, and a coronary artery bypass grafting (CABG) with the left internal thoracic artery (LITA) anastomosed to the left anterior descending artery (LAD) were then performed in a sequential manner.
authors.affiliation: The First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Terada
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Kazui
authors.forename: Katsushi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Naoki
authors.initials: N
authors.lastname: Washiyama
authors.forename: Kazuchika
authors.initials: K
authors.lastname: Suzuki
authors.forename: Takayasu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Bashar
authors.initials: B
authors.lastname: Abul Hasan Muhammad
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002114:Calcinosis / Q000175:diagnosis; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome