In 46-year-old man who had had general fatigue due to hypertension for about 20 years, only hypertension of the upper part of the body had been pointed out; the blood pressure of the upper limbs was 190mmHg and that of the lower limbs was 80mmHg. Computed tomography showed severe aortic stenosis with advanced calcification from the proximal descending thoracic aorta to the infra-renal abdominal aorta, the minimum caliber of the aorta being only 5mm. Hypertension was not controlled in spite of administration of 5 anti-hypertensive agents. Because renal factors were not related to hypertension, we chose a minimally invasive procedure: axillo-bifemoral artery bypass. After operation, the difference of blood pressure between upper and lower limbs reduced and symptoms disappeared. There are many case reports of aorto-aortic bypass for atypical coarctation, but we think that the less invasive axillo-bifemoral artery bypass is also an alternative procedure.
A 61-year-old woman was admitted to our hospital because of acute heart failure. The angiogram showed an enlarged aortic root and aortic incompetence which indicated annulo-aortic ectasia. An aortic valve-sparing operation was impossible because of severe prolapse of the aortic valve and the patient hesitated to have anti-coagulation therapy.Thus we performed aortic root replacement with the FreestyleTM stentless porcine valve (Medtronic Inc.). We plicated each original commissure in order to narrow the enlarged annulus and attach the Freestyle valve to the annulus directly by continuous suture. There was no significant difference in surgical technique and aortic cross-clamping time, compared to conventional operation. Aortic root replacement with the Freestyle valve seems an attractive option especially for elderly patients or cases in which of contraindicated for anti-coagulation therapy.
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