Simultaneous correction of aortic coarctation and bicuspid aortic valve in an adult patient (case report)
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.
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