2|Case report
A 52-year-old man presented to our department with hypertension,
recording 180/70 mmHg in the right upper limb and significantly lower
blood pressure, 90/50 mmHg, in both lower limbs. Transthoracic
echocardiography revealed a bicuspid aortic valve, mild aortic valve
regurgitation, coarctation of the aorta, and a large aortic arch
aneurysm adjacent to the left common carotid artery (FIGURE A and B).
Computed tomography confirmed these findings and additionally showed the
left subclavian artery originating from and being deformed by the
5.1×4.8 cm aneurysm (FIGURE C and D). Consequently, surgical
intervention was advised.
During the surgery, cardiopulmonary bypass and deep hypothermic
circulatory arrest were established. The aneurysm originating from the
aortic coarctation was confirmed after opening the chest. A longitudinal
incision in the posterior pericardium exposed the descending aorta.
After partial clamping, a 22-mm Dacron tube-graft was end-to-side
anastomosed to the descending thoracic aorta. The graft was then routed
along the heart’s left margin towards the ascending aorta. Following the
release of the aorta descendens clamp and removal of air from the graft,
it was proximally clamped (FIGURE E and F).”