A Case of Severe Aortic Stenosis Accompanied by Porcelain Aorta Treated with an Apicoaortic Valved Conduit

(Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka, Japan)

Norihiko Saitoh Kazuo Yamamoto Satoshi Tanaka
Chizuo Kikuchi Tsutomu Sugimoto Shigetaka Kasuya
The patient was a 70-year-old woman with severe aortic stenosis and familial hyperlipidemia which was diagnosed in 1994. The patient was admitted as an emergency case due to syncope in 2002. According to ultrasound cardiography (UCG), the pressure gradient of the aortic valve was 120.7mmHg, and the diameter of the aortic valve annulus was 16.7mm. Computed tomography showed porcelain aorta from the annulus of aortic valve to the ascending aorta. On cardiac catheterization, the pressure gradient was 96mmHg, AVA was 0.4cm2, and the ejection fraction was 38.7%. Since these findings suggested that conventional AVR was difficult, thoracotomy was performed at the left 5th intercostal level, and apicoaortic valved conduit (valved graft: SJM19HP, Intergard 22mm{Medtronic apical LV connector) was implanted. Postoperative cine MRI showed that most of the cardiac output (87%, 3.29l/min) flowed through the conduit, with the flow via the aortic valve accounting for 13%, 0.51l/min. This surgical procedure can be an effective alternative when conventional AVR is difficult.
@Jpn. J. Cardiovasc. Surg. 33: 208-212 (2004)