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[Atypical aortic coarctation (author's transl)]
Insights
Surgical repair of aortic coarctation can be complex due to anatomical variations. Bypass procedures offer a versatile solution for aortic arch and abdominal aorta coarctation, minimizing risks.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Congenital Heart Disease
Context:
- Aortic coarctation presents surgical challenges due to complex morphologies like hypoplastic segments, aneurysms, and atypical locations.
- Bypass grafting is the preferred method for aortic arch and critical abdominal aorta segments, allowing flexible reconstruction without aortic cross-clamping.
Purpose:
- To discuss surgical strategies for complex aortic coarctation, including bypass techniques and graft procedures.
- To present a rare case of combined aortic arch coarctation with situs inversus and associated vascular anomalies.
Summary:
- Bypass procedures are ideal for aortic coarctation in the aortic arch or abdominal aorta, accommodating variations in branching and avoiding aortic cross-clamping.
- Complex cases involving major branch arteries require simultaneous vascular reconstruction. Excision and Dacron grafting are used for infrarenal aneurysms secondary to coarctation.
Impact:
- This study highlights effective surgical approaches for challenging aortic coarctation cases, potentially reducing late operative risks.
- The findings emphasize the importance of tailored surgical techniques for rare combined lesions and associated vascular abnormalities.
Abstract:
Special problems in the surgical treatment of aortic coarctation may be caused by unusual morphological findings as a long hypoplastic segment, the combination with pre- or poststenotic aneurysms or by atypical localisation of the stenosis in the aortic arch, the decreasing or abdominal aorta. A bypass procedure is considered as the method of choice for the repair of coarctation in the aortic arch or the "critical zone" of the abdominal aorta (renal- and suprarenal segment). The bypass-principle allows many variations of branching and avoids cross-clamping of the aorta. The involvement of important branches as is the left common carotid, the superior mesenteric or the renal artery, necessitates a vascular reconstruction in the same session. Probably the first report about a very rare combined lesions is presented: the combination of an aortic arch coarctation in association with a complete situs inversus (right descending aorta), a common carotid trunc, an aneurysm of the left subclavian artery (first branch of the arch) and congenital cysts of the right upper lobe of the lung (Case No. 1). Usually concomitant aneurysms are found in the pre- or poststenotic aortic segment. Some of the infrarenal fusiform aneurysms (Case No. 4 and 5) are occasionally of poststenotic origin, secondary to a longstanding infrarenal coarctation. In these cases the procedure of choice is the total exstirpation and the interposition of a Dacrongraft. Important branches (as the subclavian or renal artery) can be some times inserted directly in the vascular protheses. Using the bypass technic or the patch graftplastic of Vosschulte the risk of late operation (beyond the age of 30 years) may be remarkably reduced.