Coronary revascularization in a patient with porcelain aorta and calcified great vessels.

Calcification of the aorta and great vessels in coronary artery bypass patients remains a challenging dilemma for the surgeon regarding bypass technique, choice of conduit, and available location of proximal anastomotic sites. Internal mammary artery flow may be inadequate, and the risk of systemic emboli from a diseased aorta is substantial. We report a case of a 69-year-old diabetic patient with a porcelain aorta extending into the aortic arch and great vessels who was revascularized using an altered anastomotic technique of right coronary artery endarterectomy for proximal anastomosis of vein grafts. Intraoperative echocardiographic evaluation of the aorta and arch was beneficial in determining extent of calcification.