Endarterectomy and aortic valve replacement in a patient with severely calcified ascending aortic root

A severely calcified, so-called, "porcelain" aorta may complicate aortic valve replacement (AVR). We report a case of successful AVR with an extensively calcified aortic root, involving the right coronary ostium. A 73-year-old female presented with a stenotic aortic valve with the pressure gradient of 60 mmHg. Computed tomography demonstrated extensive calcification of the ascending aortic root. Coronary angiogram showed 90% right coronary artery ostial stenosis. We endarterectomized the ascending aorta, the Valsalva sinus and the right coronary ostium, which enabled AVR with a 19 mm CarboMedics valve. These procedures might be a favorable option for the treatment of porcelain aorta and calcified aortic valve.