• Christian Schreiber, Norbert Augustin, Robert Bauernschmitt, and Rüdiger Lange.
• German Heart Center Munich, Clinic for Cardiovascular Surgery, Tehnical University, Germany. schreiber@dhm.mhn.de
• Herz. 2002 Dec 1;27(8):795-8.

BackgroundIn case of severely calcified ascending aorta, modified operative strategies are required in order to avoid manipulations of the aorta and minimize subsequent cerebral vascular accidents.Case ReportA 73-year-old woman, with a coronary two-vessel disease and aortic stenosis was scheduled for coronary artery bypass grafting and aortic valve replacement. Due to severed calcification of the ascending aorta including the transverse arch, neither cannulation, clamping nor incision of the aorta or its replacement was feasible. Therefore bypass operation was performed using a modified approach. After 1 month, implantation of a valved conduit between the left ventricular apex and the descending aorta through a lateral thoracotomy followed.ConclusionOnly in few cases the surgical treatment of a coronary artery disease in combination with left ventricular outflow tract obstruction and heavily calcified ascending aorta has been described. Undoubtedly, creation of an apicoaortic connection is today only indicated in the adult population in a small collective with multiple previous operations or porcelain aorta.

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