Simultaneous correction of aortic coarctation and bicuspid aortic valve in an adult patient (case report)
Abstract
Aortic coarctation is one of the most frequent congenital heart defects; the frequency is in the range of 6-7%. Aortic coarctation is often associated with other heart defects, namely: a bicuspid aortic valve, an interventricular septal defect, and others.
Purpose: to highlight our first experience of one-stage surgical correction of aortic coarctation and aortic valve pathology.
Material and method. A 56-year-old man was hospitalized in the department in a planned manner with symptoms of chronic heart failure. Upon admission, the main complaints were shortness of breath with minimal physical stress and increased blood pressure. Aortic coarctation was diagnosed accidentally during coronary angiography in another medical institution. The thoracic aortic CT angiography with intravenous contrast diagnosed: sharp narrowing of the aorta in a typical place.
Results and discussion. Despite a large number of publications in foreign sources, the literature review showed no cases of extra-anatomic bypass surgery of aortic coarctation with correction of a cardiac pathology in adult patients in the territory of Ukraine. The main indications for surgical correction of aortic coarctation using the technique of extra-anatomic bypass surgery include: aortic coarctation or re-coarctation in combination with a cardiac pathology requiring correction via median sternotomy; complex aortic coarctation or re-coarctation associated with technical difficulties upon choosing the method of direct anatomical correction. Based on the experience of foreign institutions, our patient had contraindications to extra-anatomic anastomosis via median sternotomy due to a constitutional peculiarity, namely a barrel chest. However, the minimally invasive surgical instruments made it possible to perform the operation successfully with reduced time required for distal anastomosis.
Conclusion. Extra-anatomic creation of anastomosis in aortic coarctation in combination with a cardiac pathology is a good alternative of treatment for an adult cohort of patients.
References
- Heinemann MK, Ziemer G, Wahlers T, Kohler A, Borst HG. Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results. Eur J CardiothoracSurg. 1997; 11:169–75.
- MertYilmaz, BulentPolat, Davit Saba. Single-stage repair of adult aortic coarctation and concomitant cardiovascular pathologies: a new alternative surgical approach. Journal of Cardiothoracic Surgery. 2006; 1(18): 8–13.
- Askin Ali Korkmaz,MustafaGuden, BurakOnan. New Technique for Single-Staged Repair of Aortic Coarctation and Coexisting Cardiac Disorder.Texas Heart Institute Journal. 2011;38 (4): 404–8.
- Said SM, Burkhart HM, Dearani JA, Connolly HM, Schaff HV. Ascending-to- descending aortic bypass: a simple solution to a complex problem. Ann ThoracSurg. 2014; 97(6):2041–7.
- Raina T, Rathnakar R, Aqarwal S. Extra Anatomic Bypass of Coarctation of the Aorta in an Adolescent: Avoiding Spinal Cord Ischemia. Journal of Medical Science. 2015; 1:31–3.
- Eva Maria Delmo Walter, Mariano Francisco del Maria Javier and Roland Hetzer. Extra-anatomical bypass in complex and recurrent aortic coarctation andhypoplastic arch. Interactive CardioVascular and Thoracic Surgery Journal. 2017; 25: 400–6.
- Luyao Ma, QunGu, Buqing Ni. Simultaneously surgical management of adult complex coarctation of aorta concomitant with intracardiac abnormality. Journal of Thoracic Disease. 2018; 10:5842–9.
