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).”