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Okamoto S, Okada T, Obata N, Iseki M, Yamane Y, Nagae M. Anesthetic management of extracorporeal membrane oxygenation-supported aortic bypass surgery for atypical coarctation with severe left ventricular dysfunction: A case report. Heliyon 2024; 10:e35605. [PMID: 39170537 PMCID: PMC11336849 DOI: 10.1016/j.heliyon.2024.e35605] [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: 06/19/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024] Open
Abstract
Atypical aortic coarctation is an exceedingly rare condition, and there are very few reported cases of anesthetic management for bypass surgery in patients with severe impaired cardiac function. We present the anesthetic management of a 68-year-old woman with atypical aortic coarctation due to Takayasu arteritis and severely impaired cardiac function, who underwent ascending-to-abdominal aorta bypass surgery under extracorporeal membrane oxygenation (ECMO). The patient's severe cardiac dysfunction was due to sustained afterload from the coarctation, leading to recurrent episodes of heart failure. Surgical intervention was deemed necessary, and a decision was made to perform a bypass operation. The patient experienced a transient state of shock following induction of anesthesia, but subsequent perioperative care was safely managed with the implementation of ECMO. For bypass surgery performed on patients with severe cardiac dysfunction due to atypical coarctation of the aorta, it is crucial to prepare for potential circulatory collapse during anesthesia induction and the surgical procedure. This preparation includes meticulous planning of the anesthesia induction method and ensuring that ECMO can be established promptly if needed.
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Affiliation(s)
- Shusuke Okamoto
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji, 670-8560, Japan
| | - Takuya Okada
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Norihiko Obata
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masahiko Iseki
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji, 670-8560, Japan
| | - Yu Yamane
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji, 670-8560, Japan
| | - Masaharu Nagae
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji, 670-8560, Japan
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Extra-anatomic bypass can treat renovascular hypertension due to atherosclerotic atypical aortic coarctation. J Vasc Surg Cases Innov Tech 2022; 9:101086. [PMID: 36747596 PMCID: PMC9898729 DOI: 10.1016/j.jvscit.2022.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Atypical aortic coarctation causing high-grade descending thoracic aortic stenosis secondary to calcified atherosclerosis is rare. We have described the case of a 75-year old man with uncontrolled renovascular hypertension secondary to this etiology. His unique anatomy meant he was not a candidate for endovascular management and his multiple comorbidities meant he was high risk for open thoracoabdominal surgery. He successfully underwent extra-anatomic bypass. Postoperatively, his renovascular hypertension improved, and he was weaned off multiple intravenous and oral antihypertensive medications. The findings from the present case suggest that extra-anatomic bypass can be a good option for treating selected patients with renovascular hypertension due to atypical aortic coarctation.
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Mikami T, Kamada T, Yano T, Nakajima T, Yasuda N, Shibata T, Nakanishi K, Harada R, Naraoka S, Toda K, Nagano N, Muranaka A, Kawaharada N. Descending thoracic aorta-abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report. J Cardiothorac Surg 2021; 16:219. [PMID: 34348745 PMCID: PMC8335882 DOI: 10.1186/s13019-021-01598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta. CASE PRESENTATION A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu's arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%. CONCLUSION In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan.
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Keitaro Nakanishi
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
| | - Kojiro Toda
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome Chuo-ku, Sapporo, 060-8543, Japan
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Inoguchi Y, Kaku B, Kitagawa N, Katsuda S. Atypical Aortic Coarctation in a Patient with an Acute Exacerbation of Multiple Organ Failure: Successful Endovascular Therapy and Spontaneous Retroperitoneal Bleeding. Intern Med 2021; 60:1547-1554. [PMID: 33328407 PMCID: PMC8188042 DOI: 10.2169/internalmedicine.6248-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022] Open
Abstract
We experienced a case of acute multiple organ ischemia and multiple organ failure due to atypical aortic coarctation (AAC). Since the patient's hemodynamics were too unstable to perform surgical revascularization, we performed urgent endovascular therapy (EVT) with a stent. Eventually, the patient achieved remission from multiple organ failure and a satisfactory clinical outcome. We feel that EVT for AAC is a sufficiently effective treatment option if the purpose of EVT is to save a patient's life in the acute phase. In the present case, spontaneous retroperitoneal bleeding (SRB) occurred after EVT of AAC, but this is a rare incident, although noteworthy in the clinical course.
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Affiliation(s)
- Yasunori Inoguchi
- Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Japan
| | - Bunji Kaku
- Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Japan
| | - Naotaka Kitagawa
- Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Japan
| | - Shoji Katsuda
- Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Japan
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Hiraya D, Sato A, Watabe H, Hoshi T, Ieda M. Axillofemoral bypass to improve congestive heart failure for atypical aortic coarctation complicating Takayasu arteritis. ESC Heart Fail 2020; 7:3184-3188. [PMID: 32558325 PMCID: PMC7524094 DOI: 10.1002/ehf2.12855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/16/2020] [Accepted: 06/02/2020] [Indexed: 11/08/2022] Open
Abstract
Atypical aortic coarctation is a rare condition associated with Takayasu arteritis, and is characterized by symptoms caused either by hypotension in the lower half of the body or secondary hypertension in the upper half of the body, and heart failure. We report a rare case of axillofemoral bypass to improve congestive heart failure for atypical aortic coarctation complicating Takayasu arteritis. Augmented vascular bed and retrograde renal blood flow after axillofemoral bypass surgery could achieve effective blood pressure control and improve renal function and cardiac function (LVEF: 30% → 55%, BNP: 2943 pg/mL → 128 pg/mL). There were two contributing factors for improvement of heart failure such as the increased vascular bed and the increase in retrograde renal blood flow. We believe that axillofemoral bypass is effective for Takayasu arteritis patients with refractory heart failure. In daily practice, careful attention should be paid to an impact of cardiorenal‐aorta interaction in atypical aortic coarctation complicating Takayasu arteritis.
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Affiliation(s)
- Daigo Hiraya
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroaki Watabe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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