Aortic valve replacement for a patient with porcelain aorta and retrosternal gastric tube reconstruction after esophageal resection

A 67-year-old woman with congestive heart failure due to aortic stenosis and regurgitation needed aortic valve replacement. She had undergone right radical mastectomy 23 years before, and total thoracic esophagectomy with retrosternal gastric tube reconstruction 11 years before. Plain computed tomography showed coincident porcelain aorta. Aortic valve replacement was performed through a median sternotomy approach. Blunt dissection on anterior and right side of the gastric tube could be done with minimal injury, and the heart was exposed as in usual cardiac surgery. Preoperative multi-detector computed tomography revealed inhomogeneous and patchy distribution of calcification in the ascending aorta, and was helpful to decide arototomy site. Aortic valve replacement was done and aortotomy was closed with felt strip buttressed running suture. Postoperative course was uneventful.