One step surgical repair of type II acute aortic dissection and aortic coarctation

Open anatomical repair for primary coarctation of the aorta in adults

OBJECTIVES

Although endovascular repair has become an alternative treatment for coarctation of the aorta (CoA) in adults, open repair provides concomitant repair of other cardiac complications, including post-stenotic aneurysm, ascending aortic aneurysm, and intracardiac diseases. We evaluated open anatomical repair for CoA repair in adults.

METHODS

Eleven patients (6 men, age range 21-63 years) underwent primary CoA repair. Complicating conditions included post-stenotic aortic aneurysm in the descending aorta in 5 patients (45.5%) and ascending aortic aneurysm in 3 (27.3%). Two patients (18.2%) had a bicuspid aortic valve, and one (9.1%) had a quadricuspid aortic valve. Ventricular septal defect was detected in 1 patient (9.1%). Eight patients (72.7%) underwent descending aorta replacement through a left thoracotomy, comprising partial cardiopulmonary bypass in 4 and deep hypothermic circulatory arrest in 4. Of those, the left subclavian artery was reconstructed in 4 patients. The remaining 3 patients (27.3%) underwent total arch replacement, through a median sternotomy in 1 and using a combination of median sternotomy and thoracotomy in 2.

RESULTS

No in-hospital mortality was observed. No spinal cord ischemia or neurological events were encountered, but 1 patient (9.1%) who underwent CoA repair via median sternotomy and thoracotomy required prolonged ventilatory support for more than 48 h. During the follow-up of 90 months (interquartile range 65-124 months), no patient died or required reintervention for the repaired segment.

CONCLUSIONS

CoA in adults could be anatomically repaired with graft replacement both through the median sternotomy, the left thoracotomy, and the combination of both approaches, according to the complicated aortic or intracardiac lesions.

Management of an ascending aortic aneurysm associated with a bicuspid aortic valve and a coarctation in an adolescent

Ascending aortic aneurysms are commonly associated with bicuspid aortic valves in adults but are rarely seen in childhood. We now report the management of an ascending aortic aneurysm in a 12-year-old male with an associated bicuspid aortic valve and a coarctation.

Emergency operation on the dissected ascending aorta of an adolescent with aortic coarctation

This case report describes the successful repair of an acute dissection of the ascending aorta in a 16-year-old girl. The dissection appeared to be related to the presence of an aortic coarctation. Furthermore, a bicuspid aortic valve was found. Echocardiography was helpful for quick pre-operative diagnosis. A computed tomography (CT) scan was used post-operatively to confirm these results. At the onset of extracorporeal circulation, active drainage was applied at the femoral vein by means of a routinely built-in shunt bypassing the venous reservoir. The practical implementation of this shunt is described in this report. One femoral artery and one femoral vein were cannulated, resulting in a blood flow index of 2.21.min(-l).m(-2) which proved to be sufficient for blood supply to both the lower and the upper parts of the body. Successful percutaneous dilatation of the coarctation was performed five months after the first operation.

Single-stage surgical repair of type II acute aortic dissection associated with coarctation of the aorta

A 36-year-old man, who was referred for severe chest pains, was found to have acute type II aortic dissection associated with a dilated ascending aorta, aortic coarctation, and congenitally bicuspid valve. A single-stage surgical repair consisting of valve-sparing aortic root implantation and graft replacement of the ascending aorta, arch, and the coarctation segment was successful.