[A successfully procedure for the high risk redo-aortic valve replacement under profound hypothermic circulatory...

A 45-year-old female with atypical coactation of aorta and aortic regurgitation was treated with aortic valve replacement and extra-anastomic bypass between the ascending aorta and the left common iliac artery using a 12 mm woven dacron graft in 1978. She had complained of palpitation and shortness of breath six years after surgery, cinefluoroscopy demonstrated prosthetic valve dysfunction. Thrombolytic therapy was carried out to improve the valve function, but it did not result in improvement. Therefore, we decided to proceed with re-surgery. During a median sternotomy, massive bleeding from the substernal graft occurred. Therefore, we abandoned the re-surgery at that time. Then, her general condition was getting worse and she had occasional pulmonary edema fifteen years after the initial surgery. She finally underwent redo-aortic valve replacement with the aid of profound hypothermic circulatory arrest and selective cerebral perfusion. There was no cerebral complication after the re-surgery and she is now leading normal life. A median sternotomy under profound hypothermic circulatory arrest and selective cerebral perfusion was a very useful and safe procedure for patients who had risks of inadvertent injury to the aorta or the heart during the re-surgery.