A 42 year old obese man with severe aortic regurgitation associated with bicuspid aortic valve and left ventricular dilatation presented with a hypertensive crisis (blood pressure [BP] 228/117 mmHg) and chest pain. Physical examination showed an ankle brachial index (ABI) of 0.6 and absent femoral pulses in both lower limbs. Computed tomography angiography showed an ascending aortic diameter of 4.7 cm and aortic coarctation with a critically stenosed aorta and prominent internal mammary arteries providing the collateral circulation. With extracorporeal circulation, reconstruction of the bicuspid aortic valve and the aortic root was done by means of the hemi-Yacoub technique and extra-aortic annuloplasty using a Dacron ring, as well as plication of the fused cusp. Moreover, an ascending to descending aortic bypass with a 19 mm expanded polytetrafluoroethylene graft was inserted after cleavage of the dorsal pericardium. The post-operative course was uneventful. The patient recovered distal pulses and had a normal ABI of 1.0 bilaterally. The patient had improvement in his hypertension (BP 133/81 mmHg) and reduced requirements for antihypertensive medications.
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Publication history
Published online: December 20, 2022
Accepted:
December 14,
2022
Received in revised form:
November 23,
2022
Received:
April 26,
2021
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© 2022 The Author(s). Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.
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