DEADLY PORCELAIN

The presence of calcium in the ascending aorta is known to be a predisposing factor for stroke after a cardiac surgical operation. Cardiac surgeons everywhere know that heart (excuse the pun!) sinking feeling when after
the pericardium is opened, the aorta is palpated and that hard patch is felt. Calcium in the aortic wall is nearly always visible on screening if looked for. This should allow time for a non contrast CT scan to be organised and the procedure planned. There are many options for the cardiac surgical management of the patient with a procelain aorta including OPCAB with insitu arterial grafts for CABG, or innominate or arch cannulation for the arterial return in other situations. In the case illustrated above, the patient required AVR and 4 grafts. The calcium was restricted to the underside of the ascending aorta. I cannulated the arch and clamped the innominate artery and the arch between the innominate and left carotid. NIRS (near infra red spectroscopy) confirmed that right sided cerebral perfusion was preserved. I therefore had plenty of room and was then able to avoid disruption of the calcium.  Whatever the solution, preoperative knowledge of the offending plaque will make planning alot easier and therefore surgery alot safer. So always keep your eyes pealed when looking at the angiogram !