False Aneurysms of an Ascending-Aorta-to-Abdominal-Aorta Bypass for Coarctation of the Aorta (original) (raw)
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Extra Anatomic Aortic Bypass Graft for Coarctation of Aorta with associated Cardiac Lesion
IOSR Journals , 2019
Coarctation of the aorta in an adult patient with associated cardiac anomaly often needs extra-anatomic bypass techniques. Among various techniques, the posterior pericardial bypass technique is commonly used,in which a Dacron conduit is anastomosed between the lateral aspect of the ascending aorta or conduit and the descending thoracic aorta posterior to the pericardium. Multiple surgical techniques have been described for the surgical treatment of adult patients with paraductal coarctation of the aorta and associated cardiac anomaly. Multiple options are, staged procedure using left thoracotomy and median sternotomy, correction of coarctation via catheter based technique along with median sternotomy, and single-stage simultaneous repair of lesions via sternotomy. We are reporting six cases of ascending aorta to descending aorta bypass without laparotomy or thoracotomy. This approach helps us to avoid surgical dissection in vicinity to the multiple colleterals and inflamed lesion and left thoracotomy which also causes bleeding from the collaterals, and to allow concomitant cardiac procedures to be performed.
Alternative Surgical Approach to Repair of the Ascending Aorta
The Annals of Thoracic Surgery, 2011
cardiac problems, as performed in our case. Exposure of the descending thoracic aorta thorough the pericardium is easy with elevation of the apex and retraction of the diaphragm [8]. Graft length is short with this intrapericardial route. In our unique approach, the coarctation site was reinforced internally by the graft, and the rupture site was plugged because reversed flow from the descending aorta compressed the graft against the aortic wall. Preparatory embolization of the major intercostal arteries also proved effective.
The International Journal of Cardiovascular Imaging, 2006
Aims: To compare MRI and MRA with Doppler-echocardiography (DE) in native and postoperative aortic coarctation, define the best MR protocol for its evaluation, compare MR with surgical findings in native coarctation.Materials and methods: 136 MR studies were performed in 121 patients divided in two groups: Group I, 55 preoperative; group II, 81 postoperative. In group I, all had DE and surgery was performed in 35 cases. In group II, DE was available for comparison in 71 cases. MR study comprised: spin-echo, cine, velocity-encoded cine (VEC) sequences and 3D contrast-enhanced MRA.Results: In group I, diagnosis of coarctation was made by DE in 33 cases and suspicion of coarctation and/or aortic arch hypoplasia in 18 cases. Aortic arch was not well demonstrated in 3 cases and DE missed one case. There was a close correlation between VEC MRI and Doppler gradient estimates across the coarctation, between MRI aortic arch diameters and surgery but a poor correlation in isthmic measurements. In group II, DE detected a normal isthmic region in 31 out of 35 cases. Postoperative anomalies (recoarctation, aortic arch hypoplasia, kinking, pseudoaneurysm) were not demonstrated with DE in 50% of cases.Conclusions: MRI is superior to DE for pre and post-treatment evaluation of aortic coarctation. An optimal MR protocol is proposed. Internal measurement of the narrowing does not correspond to the external aspect of the surgical narrowing.
Journal of Vascular Surgery, 2008
Abdominal aortic coarctation is uncommon and often complicated with coexisting splanchnic and renal artery occlusive disease. This study was undertaken to define the clinical and anatomic characteristics of this entity, as well as the technical issues and outcomes of its operative treatment. Fifty-three patients, 34 males and 19 females, underwent surgical treatment of abdominal aortic coarctations from 1963-2008 at the University of Michigan. Patient ages in years ranged from 2-4 (n = 4), 5-8 (n = 17), 9-14 (n = 16), 15-20 (n = 11) and 25-49 (n = 5). The mean age was 11.9 years. Developmental disease (n = 48), inflammatory aortitis (n = 4), and iatrogenic trauma (n = 1) were suspected etiologies. Aortic coarctations were suprarenal (n = 37), intrarenal (n = 12), or infrarenal (n = 4). Patients often had coexisting occlusive disease of the splanchnic (n = 33) and renal (n = 46) arteries. Major clinical manifestations included: aortic and renal artery-related secondary hypertension (n = 50), symptomatic lower extremity ischemia (n = 3), and intestinal angina (n = 3). Primary aortic reconstructive procedures included: thoracoabdominal bypass (n = 26), patch aortoplasty (n = 24), or an aortoaortic interposition graft (n = 3). Primary splanchnic (n = 19) or renal (n = 47) arterial reconstructions were performed as simultaneous (n = 45) or staged (n = 13) procedures in relation to the aortic surgery. Benefits existed regarding improved control of hypertension (n = 46), as well as elimination of extremity ischemia (n = 3) and mesenteric angina (n = 3). Secondary renal or splanchnic arterial reoperations (n = 8) were performed without mortality 5 days to 12 years postoperative for failed primary procedures. Secondary aortic procedures, 5 to 14 years postoperative, were performed for patch aortoplasties that became stenotic (n = 2) or aneurysmal (n = 1), and when thoracoabdominal bypasses developed an anastomotic narrowing (n = 1) or proved inadequate in size with patient growth (n = 1). No perioperative mortality accompanied either the primary or secondary aortic reconstructive procedures. Abdominal aortic coarctation represents a complex vascular disease. Individualized treatment changed little over the period of study, remaining dependent on the pattern of anatomic lesions, patient age, and anticipated growth potential. This experience documented salutary outcomes exceeding 90% following carefully performed operative therapy.
Preoperative and postoperative “aneurysm” associated with coarctation of the aorta
Journal of the American College of Cardiology, 1991
The reported incidence of aortic aneurysm after surgical repair or balloon angioplasty for aortic coarctation varies widely. To determine the incidence of aneurysm formation after surgery, preoperative and postoperative cineangiograms from 65 patients who underwent operation at age 1.5 ± 3.4 years were examined. Repair included a prosthetic patch in 14 patients, end to end anastomosis in 28 and subclavian flap in 23. Aneurysm was documented by change in contour or irregularities in contour at the repair site or by abnormal dimensions at the repair site, defined by the ratio of the widest measurement at the repair site to the measurement of the aorta at the diaphragm.