[Aortic valve replacement and coronary artery bypass grafting in a patient with a porcelain aorta due to aortitis syndrome].
Clamping a calcified aorta during cardiac operation increases the risk of cerebral embolism by aortic debris. We operated upon a 61-year-old female with severe angina pectoris due to aortic regurgitation and bilateral coronary calcific ostial stenosis associated with porcelain aorta secondary to aortitis syndrome. At operation, cardiopulmonary bypass was begun with profound hypothermia. Using an occlusion balloon catheter inflated in the ascending aorta, the calcified aorta was incised with scissors. However accidentally the balloon was ruptured by intimal calcification of the ascending aorta, and cardiopulmonary bypass was discontinued for 11 minutes under 20 degrees C hypothermia. Extensive removal of the intimal calcification of the ascending aorta was performed with care and then, the aorta was clamped. Aortic valve replacement and triple coronary bypass operation (SVG to LAD, SVG to LCX, GEA to RCA) were performed. The proximal anastomoses of the SVGs were made on the decalcified aortic wall. The postoperative course was uneventful and aortography revealed neither dissection nor dilatation of the ascending aorta following extensive decalcification procedure of the ascending aorta, and the 3 grafts were all patent. From the experience, we learned that extensive removal of calcification of the aorta can be successfully performed in porcelain aorta due to aortitis syndrome. For CABG in aortitis syndrome, the use of ITA is rarely possible, but the GEA may be a versatile graft.