A 74-year-old female presented with severe proximal hypertension. She was found to have coarctation of the aorta, calcified aortic stenosis, and an ascending aortic aneurysm. Surgery was performed through a median sternotomy to insert a 25-mm aortic valve composite graft and a 20-mm woven Dacron graft. A Bentall procedure was carried out on the 25-mm aortic valve graft. The proximal portion of the 20-mm graft was anastomosed to the lateral portion of the replaced ascending aorta and the distal portion was anastomosed to an aortotomy in the descending thoracic aorta through the pericardial space. After 2 years of follow-up, the patient is well.
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