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(Circulation. 1999;100:1131.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Aortocoronary Bypass Surgery in a Patient With Aortic Calcification

Friedrich D. Knollmann, MD; Joachim Knörig, MD

From Charité, Campus Virchow-Klinikum, Strahlenklinik (F.D.K.) and Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax-, und Gefäßchirurgie (J.K.), Berlin, Germany.

Correspondence to Dr F. Knollmann, Charité, Campus Virchow-Klinikum, Strahlenklinik, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail friedrich.knollmann@rz.hu-berlin.de

	Introduction

 
A61-year-old woman was referred for aortocoronary bypass surgery. At cardiac catheterization, calcifications of the ascending aorta were noted. To assess the exact extent of aortic calcification, we performed an ECG-gated electron-beam CT (EBCT) study of the thoracic aorta. Our image displays a 3-dimensional volume–rendering reconstruction of the EBCT data set, with thresholds set to display calcium-density voxels only. The aortic root is completely encased in calcifications, which extend to the aortic arch. The course of the three main coronary artery territories is outlined by calcific plaques. Bypass surgery was successfully completed after cannulation of the ascending aorta at a plaque-free spot in the aortic arch and occlusion of the aorta by a transventricular balloon technique for initiation of extracorporeal circulation. Complete myocardial revascularization was achieved by a left internal mammary artery bypass to the left anterior descending coronary artery and a venous Y-graft from the brachiocephalic artery trunk to the right coronary artery and the obtuse marginal branch.

View larger version (79K): [in this window] [in a new window]   Figure 1.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.