Multiple tuberculous aneurysms of the thoracoabdominal aorta extending to the aortic bifurcation.
Central MessageMultiple tuberculous mycotic aneurysms of the thoracoabdominal aorta involving the aortic arch are rare. We report the case of an 18year-old man with this condition who was treated successfully.
A 14-year-old girl underwent classical Blalock–Taussig shunt at 5 months of age. Computed tomography evaluation showed “Adachi type H” pattern of aortic arch vessels with the right common carotid artery being anastomosed to the right pulmonary artery mistaking it for the right subclavian artery.
Coarctation of the aorta (CoA) accounts for 5-8% of all congenital heart diseases. Without correction, the mean life expectancy of patients with CoA is 35 years and 90% of those patients die before reaching the age of 50 years. The various treatment options include endovascular, surgery and hybrid procedures. The endovascular treatment includes simple balloon dilatation, stent placement, and stentgraft placement. Though endovascular approaches are gaining popularity, not all CoA are suitable for the procedure. It depends on the anatomy of the lesion, associated pathology and clinical condition of the patient. The surgical techniques include resection and end-to-end anastomosis, subclavian flap repair, prosthetic patch repair and prosthetic interposition tube graft. These open surgeries can be performed with or without the aid of cardiopulmonary bypass (CPB) depending on the anatomy and collateral circulation.When using CPB for the surgery it can be performed either in normothermic or hypothermic circulatory arrest (HCA) or selective right lung ventilation with partial CPB. Meticulous care is taken during surgery, as we can encounter a lot of collaterals, which when damaged can cause profuse bleeding. Further adult CoAs are complicated by intracardiac abnormalities. These patients are managed either in a single or two stages which included extraanatomic bypass or hybrid procedures. A multidisciplinary team (consisting of cardiothoracic surgeon, interventional radiologist, cardiologist, and anaesthetist) are required to manage the unique and complex problems that affect these patients. The current management options are reviewed.
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