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Fu Y, Chen Y. Operative experience on descending aorta with Takayasu Arteritis: a review. Front Cardiovasc Med 2023; 10:1181285. [PMID: 37416916 PMCID: PMC10320220 DOI: 10.3389/fcvm.2023.1181285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Patients with Takayasu arteritis (TA) and descending aorta involvement often experience insidious onset and slow progression, leading to irreversible vascular lesions despite medication therapy. Surgical management plays a crucial role in resolving hemodynamic disturbances and has shown promise in improving the outcomes of this patient population, owing to significant advancements in surgical expertise. However, studies focusing on this rare disease are lacking. This review summarizes the characteristics of patients with stenosis in descending aorta, emphasizing surgical approaches, perioperative management, and disease outcomes. The operative approach depends on lesion location and extent. Existing studies have confirmed that the choice of surgical modality significantly influences postoperative complications and long-term prognosis in patients, highlighting the effectiveness of bypass surgery as a favorable option in clinical practice with a satisfactory long-term patency rate. To mitigate postoperative complications, it is advisable to conduct regular imaging follow-ups to prevent the deterioration of the condition. Notably, the occurrence of restenosis and pseudoaneurysm formation deserves particular attention due to their impact on patient survival. The use of perioperative medication remains a topic of debate, as previous studies have presented divergent perspectives. The primary objective of this review is to provide a comprehensive perspective on surgical treatment and offer customized surgical approaches for patients in this population.
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Zhao L, Zhu L, Zhao QM, He L, Liang XC, Wang LS, Wu L. Mid-aortic syndrome: a rare cause of heart failure in infants. ESC Heart Fail 2022; 9:3619-3624. [PMID: 35818131 DOI: 10.1002/ehf2.14066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/04/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
This case reports describe a rare disease, mid-aortic syndrome (MAS), that can cause severe heart failure and hypertension in infancy. The typical images, key points of diagnosis, and therapy methods of the disease have also been presented. We report two critical thoracoabdominal aortic coarctation cases in infants aged 2 and 11 months with severe heart failure. The patients were initially misdiagnosed as dilated myocardiopathy, with the correct diagnosis confirmed through imaging. Both patients underwent balloon angioplasty; one patient also had bare-metal stents implanted. The patient treated with balloon angioplasty alone died after the procedure, whereas the other patient recovered well. In conclusion, careful physical examinations, especially upper and lower extremity blood pressure differences and palpation of upper and lower limb pulses, are critical in unexplained infant heart failure cases. Stent implantation may be a safer and more effective treatment than simple balloon angioplasty in infants with MAS.
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Affiliation(s)
- Lu Zhao
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Li Zhu
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Qu-Ming Zhao
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Lan He
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xue-Cun Liang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Lai-Shuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Lin Wu
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, 201102, China
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Lazea C, Al-Khzouz C, Sufana C, Miclea D, Asavoaie C, Filimon I, Fufezan O. Diagnosis and Management of Genetic Causes of Middle Aortic Syndrome in Children: A Comprehensive Literature Review. Ther Clin Risk Manag 2022; 18:233-248. [PMID: 35330917 PMCID: PMC8938167 DOI: 10.2147/tcrm.s348366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Cecilia Lazea
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Correspondence: Cecilia Lazea, Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, 68, Motilor Street, Cluj-Napoca, 400370, Romania, Tel +40 744353764, Email ;
| | - Camelia Al-Khzouz
- Department Mother and Child, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Crina Sufana
- Department of Pediatrics I, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Diana Miclea
- Department of Medical Genetics, Emergency Pediatric Hospital, Cluj-Napoca, Romania
- Department of Molecular Sciences, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Ioana Filimon
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Department of Radiology and Medical Imaging, Emergency Pediatric Hospital, Cluj-Napoca, Romania
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Kim SS, Stein DR, Ferguson MA, Porras D, Chaudry G, Singh MN, Smoot L, Kim HB, Vakili K. Surgical management of pediatric renovascular hypertension and midaortic syndrome at a single-center multidisciplinary program. J Vasc Surg 2020; 74:79-89.e2. [PMID: 33340698 DOI: 10.1016/j.jvs.2020.12.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the outcomes of various surgical approaches in the treatment of renovascular hypertension and midaortic syndrome (MAS) in children. METHODS We performed a retrospective medical record review of patients who had undergone surgery for renovascular hypertension from 2010 to 2018 at our center under the care of a multidisciplinary team. The operative interventions included mesenteric artery growth improves circulation (MAGIC), tissue expander-stimulated lengthening of arteries (TESLA), aortic bypass using polytetrafluorethylene, renal artery reimplantation, and autotransplantation. The MAGIC procedure uses the meandering mesenteric artery as a free conduit for aortic bypass. The TESLA procedure is based on lengthening the normal distal aorta and iliac arteries by gradual filling of a retroaortic tissue expander for several weeks, followed by resection of the stenotic aorta and subsequent primary reconstruction. RESULTS A total of 39 patients were identified, 10 with isolated renal artery stenosis, 26 with MAS, and 3 with systemic inflammatory vasculitis. The median age at presentation and surgery was 6.4 years (range, 0-16.3 years) and 9.3 years (range, 0-9.2 years), respectively. The MAS-associated syndromes included neurofibromatosis type 1 (15.4%) and Williams syndrome (5.1%), although most cases were idiopathic. At surgery, 33.3% had had stage 1 hypertension (HTN), 53.8% stage 2 HTN, and 12.8% normal blood pressure with a median of three antihypertensive medications. Follow-up of 37 patients at a median of 2.5 years demonstrated normal blood pressure in 86.1%, stage 1 HTN in 8.3%, and stage 2 HTN in 5.6%, with a median of one antihypertensive medication for the entire cohort. CONCLUSIONS The patterns of vascular involvement leading to renovascular hypertension in children are variable and complex, requiring thoughtful multidisciplinary planning and surgical decision-making. The MAGIC and TESLA procedures provide feasible approaches for aortic bypass and reconstruction using autologous tissues and will result in normalization of blood pressure in 85% of children 2.5 years after surgery.
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Affiliation(s)
- Stephanie S Kim
- Department of Surgery, Boston Children's Hospital, Boston, Mass
| | - Deborah R Stein
- Division of Nephrology, Boston Children's Hospital, Boston, Mass
| | | | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Gulraiz Chaudry
- Division of Interventional Radiology, Boston Children's Hospital, Boston, Mass
| | - Michael N Singh
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Leslie Smoot
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, Boston, Mass
| | - Khashayar Vakili
- Department of Surgery, Boston Children's Hospital, Boston, Mass.
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Javier Delmo EM, Javier MFDM, Hetzer R. Consecutive surgical sequelae in children and adolescents with Marfan syndrome after primary cardiovascular surgical interventions. Eur J Cardiothorac Surg 2020; 57:54-62. [PMID: 31098609 DOI: 10.1093/ejcts/ezz143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study focuses on the consecutive sequelae of children and adolescents with Marfan syndrome after primary cardiovascular surgical interventions and the long-term outcomes. METHODS A retrospective review of children with Marfan syndrome who underwent primary surgical intervention in childhood (<18 years) and sequential cardiovascular operations between July 1986 and September 2014 was undertaken. RESULTS Thirty-six children (mean age 12.38 ± 4.4, range 0.62-17.14 years, at the first operation; 12 females) underwent a total of 97 sequential cardiovascular operations. Primary pathologies were annuloaortic ectasia, aortic root and ascending aorta aneurysm, aortic valve insufficiency, floppy mitral valve and midaortic syndrome. Initial operations were emergency in 2 and urgent and elective in 10 and 24 patients, respectively. Associated skeletal abnormalities were seen in 8. All underwent a second operation; 17 underwent a third operation; 6 had a fourth; and 2 had a fifth. The survival rate of children <13 years of age at the first operation compared to those who were older and male, was not statistically significant (P = 0.244). The cumulative survival rate based on age at first operation was 63.24 ± 0.16% at a mean follow-up period of 13.9 ± 6.8 (median 11.8, range 2-32.6) years. CONCLUSIONS Patients with Marfan syndrome undergoing surgery during childhood needed sequential reinterventions. However, even with multiple consecutive surgeries, long-term outcome is deemed satisfactory.
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Affiliation(s)
| | | | - Roland Hetzer
- Department of Cardiothoracic Surgery, Cardio Centrum Berlin, Berlin, Germany
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Xue Y, Zhu X, Zhou Q, Wang D. Intracardiac operation concomitant with extra-anatomic bypass for complex aorta coarctation. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sugawara H, Goto H, Akamatsu D, Hamada Y, Tsuchida K, Yoshida Y, Umetsu M, Suzuki S, Horii S, Ogasawara N, Takahashi H, Watanabe T, Kamei T. Midaortic Syndrome due to Takayasu Arteritis in a Child with Acute Decompensated Cardiac Failure Managed by an Emergency Axillo-External Iliac Artery Bypass: A Follow-Up Case Report of Long-Term Outcomes. Ann Vasc Surg 2019; 64:408.e5-408.e9. [PMID: 31634602 DOI: 10.1016/j.avsg.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/17/2019] [Accepted: 09/19/2019] [Indexed: 11/29/2022]
Abstract
Midaortic syndrome (MAS) is characterized by a diffuse narrowing of the distal thoracic or abdominal aorta and is concomitant with various etiologies. The common symptoms of MAS include severe hypertension or arterial insufficiency distal to the stenosis. This includes lower extremity claudication and heart failure due to afterload mismatch. We present the case of an 8-year-old girl who developed acute decompensated cardiac, respiratory, and renal failures because of the occlusion of the descending aorta secondary to Takayasu arteritis (TA). Although thoracoabdominal-aortic bypass is usually performed for patients with MAS, the procedure was considered too invasive, given the patient's condition. Therefore, we performed an emergency axillo-external iliac artery bypass for revascularization. Subsequently, organ failure improved and she was discharged. At postoperative 10 years, an asymptomatic pseudoaneurysm was detected at the distal anastomosis, for which revision surgery was performed. Overall, the long-term prognosis was satisfactory, suggesting that this procedure is less invasive and effective for treatment of MAS due to TA, in emergencies.
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Affiliation(s)
- Hirofumi Sugawara
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan.
| | - Hitoshi Goto
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Daijirou Akamatsu
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Yoh Hamada
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Ken Tsuchida
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Yoshitaro Yoshida
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Michihisa Umetsu
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Shunya Suzuki
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Shinichiro Horii
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Norinobu Ogasawara
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Hirokazu Takahashi
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
| | - Tetsuo Watanabe
- Department of Cardiovascular Surgery, Sendai City Hospital, Taihaku-ku, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Hospital, Aoba-ku, Sendai, Japan
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Kim YS, Cho YH, Sung K, Kim DK, Chung S, Park TK, Kim WS. Clinical Outcome of Extraanatomic Bypass for Midaortic Syndrome Caused by Takayasu Arteritis. Ann Thorac Surg 2019; 109:1419-1425. [PMID: 31557481 DOI: 10.1016/j.athoracsur.2019.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We investigated long-term outcomes and cardiac function after extraanatomic bypass surgery for Takayasu arteritis and midaortic syndrome. METHODS Between 2007 and 2016, 14 patients underwent extraanatomic bypass for Takayasu arteritis. Median age was 56.6 years. Median systolic pressure gradient in the stenotic lesion was 79 mm Hg. Nine patients underwent bypass surgery from the ascending aorta to the infrarenal aorta, 2 from the ascending aorta to the distal descending thoracic aorta, 1 from the ascending aorta to the supraceliac abdominal aorta, 1 from the descending thoracic aorta to the infrarenal abdominal aorta, and 1 from the descending thoracic aorta to the descending thoracic aorta. Five underwent additional 6 peripheral bypass procedures, and 6 underwent concomitant heart surgery. RESULTS There were no early deaths. Median hospital stay was 10.5 days. Median follow-up duration was 36.3 months, and late death occurred in 2 patients. One died at 1 year postoperatively because of an infection due to pancreatic injury and mediastinitis. The other was lost to follow-up, and death was confirmed through the national insurance database. No anastomotic site stenosis or aneurysmal change occurred. The number of antihypertensive medications was reduced significantly in all but 1 patient, and organ ischemia symptoms, including dizziness, visual disturbance, and claudication, improved in all patients. Interventricular septal diameter and left ventricular mass index decreased significantly. Serum creatinine level also decreased. Overall estimated 5-year survival was 79% ± 13%. CONCLUSIONS Extraanatomic bypass for Takayasu arteritis is safe and effective and can be useful for left ventricular unloading and reduction of organ ischemia.
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Affiliation(s)
- Young Su Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Jiménez CE, Randial L, Robles A, Rozo JP. Coartación aórtica abdominal en un lactante de tres meses. Tratamiento por vía endovascular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Zartner P, Hart C, Schneider MBE. Severe midaortic syndrome: a stepwise approach to treatment with drug-eluting balloons: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:ytz017. [PMID: 31020259 PMCID: PMC6439396 DOI: 10.1093/ehjcr/ytz017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/04/2019] [Indexed: 11/12/2022]
Abstract
Background Severe forms of the midaortic syndrome cause persistent arterial hypertension and can lead to angina abdominalis. Untreated, morbidity, and mortality are significant. In addition to palliation through bypass surgery, few other therapeutic approaches lead to a long-term relief. Drug-eluting balloons (DEB) covered with paclitaxel, a cytostatic drug, have proven to be effective in bifurcational lesions and for in-stent stenoses in coronary arteries. Case summary In a 15-year-old girl with severe midaortic syndrome and multiple collateral arteries, four interventional balloon dilatations with DEB of increasing diameters resolved the stenosis within 8 months. After a procedure free interval of now 2.7 years, the anatomical and the physical condition of the patient remained unchanged. Discussion This stepwise approach, with a low procedural risk and a lasting result may justify further investigations into this combined treatment.
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Affiliation(s)
- Peter Zartner
- Department of Cardiology, German Paediatric Heart Center, Arnold Janssen Str. 29, Sankt Augustin, Germany
| | - Christopher Hart
- Department of Cardiology, German Paediatric Heart Center, Arnold Janssen Str. 29, Sankt Augustin, Germany
| | - Martin B E Schneider
- Department of Cardiology, German Paediatric Heart Center, Arnold Janssen Str. 29, Sankt Augustin, Germany
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Successful staged management of neonatal midaortic syndrome. J Thorac Cardiovasc Surg 2019; 157:e281-e283. [PMID: 30638616 DOI: 10.1016/j.jtcvs.2018.11.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 11/23/2022]
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Yu Z, Minakawa M, Kondo N, Daitoku K, Fukuda I. Total arch replacement for aortic arch aneurysm with coexisting middle aortic syndrome. Int J Surg Case Rep 2018; 54:79-82. [PMID: 30544040 PMCID: PMC6290257 DOI: 10.1016/j.ijscr.2018.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 12/03/2022] Open
Abstract
Middle aortic syndrome (MAS) combined with thoracic aortic aneurysm (TAA) is a rare vascular disease. Combined operation of total arch replacement and a bypass from the ascending aorta to the bifemoral arteries is alternative for MAS combined with TAA. One stage open surgery got good clinical outcome for this condition without any another intervention postoperative.
Introduction: Middle aortic syndrome (MAS) combined with thoracic aortic aneurysm (TAA) is a rare vascular disease. One stage open surgery to treat this condition, becomes a challenge for our cardiovascular surgery. Presentation of case: A 69-year-old man presented with a saccular type aortic arch aneurysm, shaggy aorta and severe atherosclerotic stenosis of the thoracoabdominal aorta with middle aortic syndrome and aberrant right subclavian artery, renovascular hypertension, renal dysfunction, and intermittent claudication of both legs. Total arch replacement procedure was performed under a cardiopulmonary bypass using aortic inflow from the right axillary artery and a femoro-femoral crossover bypass graft to avoid malperfusion of the lower body. Before weaning from the cardiopulmonary bypass, we established an extra-anatomical bypass from the ascending aortic graft to the femoro-femoral crossover bypass graft. 3D-CT showed patency of bypass graft without any sign of stenosis postoperative. The patient’s postoperative course was uneventful and he was discharged from hospital with improvements in intermittent claudication, hypertension, and renal dysfunction. Discussion: Although open surgery including graft bypass for MAS is more invasive than endovascular treatment, it could be performed successfully to preventing from intraoperative complication or complications postoperatively. Conclusion: Combined operation of total arch replacement and a bypass from the ascending aorta to the bifemoral arteries is alternative for MAS combined with TAA.
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Affiliation(s)
- Zaiqiang Yu
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
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The fate of a thoracoabdominal aortic bypass graft 10 years after surgery in a child with the middle aortic syndrome. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:476-479. [PMID: 32082783 DOI: 10.5606/tgkdc.dergisi.2018.14384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/29/2018] [Indexed: 11/21/2022]
Abstract
A 13-year-old boy who underwent thoracoabdominal aortic bypass when he was three years old for middle aortic syndrome was admitted with fatigue and need for an increased dose of antihypertensive mediations. The graft was patent, but there were stenoses at the juxta-proximal and juxta-distal anastomosis sites. A partial benefit was gained with endovascular stenting. Although postponement of surgery, until the child reaches full growth is preferred, surgery remains the inevitable treatment of choice in patients with middle aortic syndrome. In contrary, it is important to use the graft as large as possible during the initial operation to avoid patient-graft mismatch in the future.
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14
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Kim HB, Vakili K, Ramos-Gonzalez GJ, Stein DR, Ferguson MA, Porras D, Lock JE, Chaudry G, Alomari A, Fishman SJ. Tissue expander-stimulated lengthening of arteries for the treatment of midaortic syndrome in children. J Vasc Surg 2018; 67:1664-1672. [DOI: 10.1016/j.jvs.2017.09.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
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Delmo Walter EM, Javier MFDM, Hetzer R. Extra-anatomical bypass in complex and recurrent aortic coarctation and hypoplastic arch. Interact Cardiovasc Thorac Surg 2017; 25:400-406. [PMID: 28498910 DOI: 10.1093/icvts/ivx115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/15/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to report the selection schemes, technical variations and long-term outcome of extra-anatomical bypass to correct complex, recurrent aortic coarctation and hypoplastic aortic arch. METHODS Between 1989 and 2012, 53 patients (mean age 13.2 ± 4.3, median 11.6, range 9-23 years) with complex aortic coarctation (n = 33; long-segment hypoplastic aortic arch in 15), recurrent coarctation (n = 20; anastomosic pseudoaneurysm in 10), underwent correction using extra-anatomical bypass, either with (n = 18: femoral bypass = 13, left heart bypass = 5) or without (n = 35) extracorporeal circulation via a left lateral thoracotomy (n= 48) and combined median sternotomy and median laparotomy (n = 5). The decision to use extracorporeal circulation was based on the anatomical location of the coarctation, the length of the hypoplasia and a history of previous repair. Preoperatively, mean systolic blood pressure was 130 ± 30 mmHg at rest and 180 ± 40 mmHg during exercise, with a mean pressure gradient of 80 ± 11.6 (range 40-120) mmHg. RESULTS Various extra-anatomical bypass strategies included left subclavian artery to descending aorta (n = 38), ascending aorta to left subclavian artery (n = 3), ascending aorta to descending aorta (n = 4), aortic arch to descending aorta (n = 3) and ascending aorta to abdominal aorta (n = 5). Graft size (median 18, range 10-26, mm) was chosen according to the diameter of the vessel proximal and distal to the planned graft. No operative deaths, paraplegia or abdominal malperfusion occurred. The mean reduction in systolic blood pressure was 60 ± 25 mmHg without pressure gradients. During a mean follow-up of 18.3 ± 3.7 years, there were no reoperations, graft complications or pseudoaneurysm formation on anastomotic sites. Seven (11.6%) patients are on antihypertensive medications. No patient presented with claudication nor did anyone experience orthostatic problems from the steal phenomenon. CONCLUSIONS Extra-anatomical bypass is safe, an effective technique, and achieves satisfactory long-term results.
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Affiliation(s)
- Eva Maria Delmo Walter
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | | | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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Yoo R, Alomari AI, Shaikh R, Davis SL, Ferguson MA, Vakili K, Kim HB, Chaudry G. Catheter-Directed Thrombolysis in a Child with Bilateral Renal Artery Graft Thrombosis. J Vasc Interv Radiol 2017; 28:1184-1188. [DOI: 10.1016/j.jvir.2016.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022] Open
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Ali MS, Tchernodrinski S, Mohananey D, Ali AS. Unlikely culprit: congenital middle aortic syndrome diagnosed in the sixth decade of life. BMJ Case Rep 2016; 2016:bcr-2016-216773. [PMID: 27530881 DOI: 10.1136/bcr-2016-216773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old woman was admitted with acute heart failure. She had a long history of resistant hypertension, with an unremarkable work up for secondary causes in the past. Her brachial blood pressure was 210/70 mm Hg, with ankle blood pressure of 100/70 mm Hg. CT angiogram revealed marked narrowing of the descending thoracic aorta between the left subclavian artery and the diaphragm, consistent with middle aortic syndrome (MAS). She was initially managed with diuretics and antihypertensives. Subsequently thoracotomy revealed a severely hypoplastic segment of the descending aorta. The diseased segment was resected and aortic reconstruction performed. Histopathology showed fragmentation of the medial elastic fibres and fibrosis of the medial and intimal layers. These findings along with gross aortic hypoplasia and absence of features of Takayasu's arteritis, suggest that our patient had congenital MAS. The patient has done well since her surgery. We believe this is the first case of congenital MAS reported in the sixth decade of life.
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Affiliation(s)
- Muhammad Sajawal Ali
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Stefan Tchernodrinski
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Divyanshu Mohananey
- Department of Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
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Long-segment thoracoabdominal aortic coarctation in a child with Down syndrome. J Vasc Surg Cases 2015; 1:171-173. [PMID: 31724602 PMCID: PMC6849921 DOI: 10.1016/j.jvsc.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/16/2015] [Indexed: 11/20/2022] Open
Abstract
Midaortic syndrome is a rare vascular anomaly characterized by coarctation of the descending thoracic and abdominal aorta. Down syndrome is associated with multiple congenital cardiac malformations but is rarely associated with developmental vascular anomalies. Midaortic syndrome may result in severe renovascular hypertension that requires early intervention to prevent life-threatening complications. We report a child with Down syndrome who presented with occlusion of the aorta and was treated with aortic bypass. More than 4 years after the procedure, the patient's renal function remains normal, and there is no evidence of recurrent hypertension. Long-term follow-up is important to assess the benefits of surgical repair.
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Descending aorta-external iliac artery bypass for middle aortic syndrome. Heart Vessels 2013; 29:864-6. [PMID: 24275906 DOI: 10.1007/s00380-013-0441-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
Abstract
We encountered a surgical case of middle aortic syndrome (MAS) in a 56-year-old man who had resistant hypertension. Computed tomography showed severe stenosis of the abdominal aorta from below the superior mesenteric artery to above the inferior mesenteric artery. Although bilateral renal artery stenosis was confirmed, renal function was within normal limits. A 10-mm vascular prosthetic graft was used to perform a descending aorta to left external iliac artery bypass. His hypertension was well controlled without medication. This extra-anatomic bypass may be a simple and useful approach for treating MAS if it is not necessary to reconstruct the renal artery or visceral artery.
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