One-stage surgical approach to coarctation of the aorta and ascending aortic aneurysm

Abstract

Abstract:Background: Aortic coarctation in adults is sometimes associated with concomitant cardiovascular pathologies which require intervention. The optimal operative approach for such patients remains unsettled. An extra-anatomic aortic bypass from the ascending aorta to the descending aorta via median sternotomy allows simultaneous performance of repair of complex aortic coarctation and concomitant cardiac operation. Case report: We present herein an adult female with coarctation of the aorta combined with an ascending aortic aneurysm associated with concomitant aortic valve regurgitation. We performed a single-stage operation which consisted of Bentall's procedure and extra-anatomic bypass from the ascending to the descending aorta. The patient's postoperative period was uneventful and twelve months after the surgery she is doing well. The conclusions of our work resulted in one essential experience, namely that clinically serious, previously almost intractable conditions can be successfully resolved in unusual ways. Extra-anatomic reconstruction of aorta coarctation that for various reasons could not have been solved by resection of the affected aortic segment allowed us to achieve a structurally as well as functionally excellent outcome. Therefore, we recommend to consider this option in appropriate patients and/or incorporate it into the therapeutic armamentarium of cardiosurgical centers (Fig. 5, Ref. 11 Coarctation of the aorta is a common congenital defect which, unless primarily detected and surgically corrected in childhood, may remain undiagnosed until adulthood. In most patients it is then discovered during examination of systemic hypertension (1). Moreover, coarctation is commonly associated with concomitant cardiac congenital or acquired pathology that may require surgical intervention. In addition, 5 % to 30 % of patients with previous coarctation repair have recoarctation and require reintervention (2).Aortic coarctation is a serious pathology which requires surgical or endovascular treatment. About 50 % of cases of uncorrected isolated aortic coarctation are lost up to the age of 10; only 10 % may reach the age of 50. The most common reason for death from untreated aortic coarctation is the rupture of aortic aneurysm or side branches with a rate of 23 % (3).The management of aortic coarctation associated with other cardiac pathology in adults appears to be a great surgical challenge. Insuffi cient clinical data due to the small number of these patients on the one hand and a large variety of complicating factors on the other are the reasons why there is no consensus on the optimal approach. Debates exist not only as to which lesion should be corrected fi rst but also in regard to the type and timing of the procedure. Surgery can be one-or two-staged (4). An alternative surgical approach is an anatomic left-sided short aortic bypass from the arcus aorta to the descending aorta via median sternotomy, which allows a simultaneous repair of a complex aortic coarctation and concomitant cardiac operat...

Repair of Coarctation of The Aorta, Bicuspid Aortic Valve, Subaortic Membrane and Ascending Aotic Aneurysm in A Single Session

“…(6) Using a side-clamp for the proximal and distal anastomoses of the graft for the extra-anatomic correction of coarctation prevents paraplegia, allowing the blood flow to the branches of the aorta and the intercostal arteries. (2) In this case, we prefered to place Dacron graft above the phrenic nerve through the lateral pericardium and paid attention to avoid vagal and phrenic nerve injuries. As a result; the repair of COA accompanying with cardiac pathologies like AAA or AD, BAV, ventricular septal defects in one single operation can be managed safely.…”

“…10% of COA cases are diagnosed higher than 40-year of age and other cardiac pathologies accompany to 40% of these cases. (2,3) The cause of mortality in 20% of undiagonised COA cases is the aortic rupture of ascending aorta, and in 75% of instances, rupture occurred in the ascending aorta. (4) Although the association between COA and aneurysm of the ascending aorta (AAA) or aortic dissections (AD) has been wellknown, surgical treatment of accompanying pathologies of the ascending aorta in patients with COA have been uncommon.…”