Extra-anatomical Bypass in a Case of Recoarctation and Previous Cardiac Surgery
Assen Keltchev1, Kristiyanna Mavrodieva1, Andrey Neutov1
1Department of Cardiosurgery, Acibadem City Clinic, University of Sofia, Sofia, BGR.
Insights
This case study details a complex aortic recoarctation in a 61-year-old patient with prior cardiac surgeries. An extra-anatomic bypass was successfully performed to address the recurrent aortic stenosis.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- A 61-year-old male with a history of two prior cardiac operations presented with symptoms suggestive of aortic re-stenosis.
- The patient previously underwent repair of post-ductal coarctation of the aorta (CoA) with resection and end-to-end anastomosis at age 10.
- Additionally, the patient had a mitral valve replacement with a mechanical prosthesis ten years prior due to severe mitral insufficiency.
Observation:
- The patient was admitted due to recurrent symptoms indicative of aortic re-stenosis, specifically in the area of the previous coarctation repair.
- Diagnostic evaluation confirmed significant re-stenosis at the site of the prior aortic coarctation repair.
Findings:
- Surgical intervention involved the creation of an extra-anatomic bypass.
- The bypass was constructed between the ascending aorta and the abdominal aorta.
- The graft traversed a newly created diaphragmatic opening anterior to the right lung hilum.
Implications:
- This case highlights the feasibility of extra-anatomic bypass for complex aortic recoarctation in patients with multiple previous sternotomies and thoracotomies.
- The successful management of this challenging case demonstrates an alternative surgical strategy for recurrent aortic coarctation.
- This approach may be considered for patients unsuitable for conventional re-operative aortic repair.
Abstract:
A complex clinical case of aortic recoarctation is presented. The case is a 61-year-old comorbid patient with two previous aortic and cardiac operations. At the age of 10, the patient underwent surgery for post-ductal coarctation of the aorta (adult type) at the typical site, where the stenotic area was completely resected, and an end-to-end anastomosis was performed through a left-sided thoracotomy. Ten years ago, the patient also had mitral valve replacement with a metallic prosthesis due to severe mitral insufficiency, performed via median sternotomy. The patient was admitted to the cardiac surgery unit due to symptoms suggestive of aortic re-stenosis due to status post repair of coarctation of the aorta (resection with end-to-end anastomosis). An extra-anatomic bypass was performed between the ascending and abdominal aorta, with the graft passing through a new diaphragm opening in front of the hilus of the right lung.
