Pseudocoarctation and mid-arch aortic coarctation

The adult with repaired coarctation of the aorta

Coarctation of the aorta is a common congenital lesion that may often be repaired or intervened upon early in life. The management of patients with this disorder revolves around the concept that although the coarctation may be treated, what remains is a diffuse systemic cardiovascular disorder. Careful clinical care and investigation is required to reduce morbidity from recurrent disease and residual lesions. The natural and modified history of the disorder is reviewed. This article focuses on the clinical care of adults with repaired coarctation and includes a review of clinical goals and investigation as well as indications for reintervention.

Left cervical aortic arch associated with pseudocoarctation and aortic and mitral regurgitation: one-stage surgical repair

Cervical aortic arch is rare with a prevalence of less than 1/10000 live births (Pediatr Cardiol 10 (1989) 205); but may occur with other cardiovascular congenital abnormalities. We report pseudocoarctation of a left-sided cervical aortic arch with an aberrant right subclavian artery and aortic and mitral regurgitation, corrected by an anterior mediastinal shunt from ascending to descending aorta and aortic and mitral valve replacements, as a one-stage procedure.

[Aortic pseudocoarctation complicated by a giant pseudoaneurysm]

Pseudocoarctation of the aorta is an infrequent anomaly caused by the elongation and the congenital kinking of the aorta. We present a case of pseudocoarctation of the aorta with saccular aneurysm complicated with a large pseudoaneurysm. Both, magnetic resonance and aortography showed an aneurysm of the aortic isthmus that extended/progressed as pseudoaneurysm towards the neck. The patient was asymptomatic but due to the high risk of rupture, she underwent surgical reparation. The revision of the literature and our experience with this case show that pseudocoarctation of the aorta is not always a benign pathology and that surgical reparation should be performed in all those cases that are complicated by aneurysm.

Operation of mid-arch coarctation

BACKGROUND

Coarctation occurring within the aortic arch is rare and may present difficulties during surgical repair. We describe the operative technique and outcome in 6 patients with this unusual anomaly.

METHODS

Five patients had antegrade perfusion with circulatory arrest. Three patients with presubclavian narrowing (one presenting with type B dissection) were operated through extended left thoracotomy. Two precarotid and paracarotid lesions were approached through a median sternotomy. All patients were perfused antegradely from the ascending aorta and operated with hypothermic circulatory arrest. One patient who had a complex presubclavian coarctation after two previous repairs received an ascending aorta to abdominal aorta bypass graft without cardiopulmonary bypass.

RESULTS

All patients survived operation and are well at a mean follow-up of 3.3 years after the procedure. None had cerebral problems or spinal cord injury. Renal function was unchanged. The mean (+/- standard error of the mean) resting gradient across the coarctation decreased from 42+/-4.0 mm Hg to 6+/-1.2 mm Hg (p = 0.0004).

CONCLUSIONS

Hypothermic circulatory arrest using antegrade ascending aortic perfusion allows safe and effective repair of mid-arch coarctation. Complicated reoperations can be managed safely using ascending-to-abdominal aortic bypass.

Congenital septation of the aortic arch with carotid stenosis

A 14-year-old white boy presented with syncope and a left carotid bruit. Arch aortogram showed narrowing of the distal aortic arch, left carotid stenosis, and small left subclavian and vertebral arteries. When aortic arch replacement was carried out a vertical septum was found in the distal arch. Histologic examination suggested this was ductal in origin.

Pseudocoarctation of the aorta presenting as a mediastinal mass with dysphagia

Pseudocoarctation is an uncommon anomaly thought to be caused by congenital elongation and kinking of the aorta. We report a case of pseudocoarctation of the aorta presenting as a superior mediastinal mass causing dysphagia. Aortography and echocardiography revealed dilatation of the aorta and an aneurysm below the level of the pseudocoarctation. The patient underwent operative repair of the pseudocoarctation and associated aneurysm with good symptomatic relief. Review of the literature and experience with this case demonstrate that pseudocoarctation of the aorta cannot necessarily be regarded as a benign condition. Surgical treatment is recommended for all symptomatic patients and for those with associated aneurysm formation.

Pseudocoarctation of the aorta

We report a case of a 50-year-old man with pseudocoarctation of the aorta that we examined with magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). The MR images demonstrated the characteristic "kink" of the aorta and the absence of true coarctation. These appearances were confirmed by DSA, but we believe MRI to be the better method for examining the aorta because it is non-invasive and has the ability to display the mediastinal anatomy in the sagittal plane, in addition to the axial and coronal planes.

Coarctation of the midaortic arch presenting with monoparesis

A 6 1/2-month-old infant was seen with right-arm monoparesis, right upper extremity hypertension, and findings of a coarctation located in the midaortic arch between the innominate and left common carotid arteries. Associated left cerebral atrophy (Dyke-Davidoff syndrome) was documented by computed tomography. Excision of the coarctation segment with primary repair of the arch and reanastomosis of the left carotid to the innominate artery was accomplished.

Hemodynamic and angiographic findings in a case of kinking of the aorta

The authors report a case of aortic kinking associated with abnormalities of size of aortic arch vessels. The diagnostic aid of hemodynamic and angiographic techniques is emphasized. The possibility that aortic kinking and the abnormalities of aortic arch vessels may be etiologically related is suggested.