Clinical and Hemodynamic Follow-up of a Patient After Operation for Dissection of an Ascending Aortic Aneurysm Secondary to Coarctation of the Aorta

Abstract

SUMMARYWe present clinical follow-up of a 20-year-old male with an aortic aneurysm secondary to aortic coarctation. The diagnosis of aortic aneurysm secondary to aortic coarctation was made in 1997. The patient did not agree to undergo any invasive or therapeutic procedures at that time. He presented to an emergency unit with severe chest pain after chest trauma obtained during judo exercises in 1998. Two-dimensional echocardiography showed bicuspid aortic valves, an ascending aortic aneurysm 6 cm in diameter with an intimal flap and false lumen, aortic coarctation distal to the left subclavian artery, and aortic insufficiency secondary to annular dilatation. Type II aortic dissection was confirmed by transesophageal echocardiography, which showed the dissection was confined to the ascending aorta. The dissection extended to the beginning of the arcus aorta.Following stabilization of the patient's clinical condition, balloon coarctation angioplasty was performed to reduce afterload and hypertension and to facilitate femoral artery cannulation for cardiopulmonary bypass. Surgical procedures included resection of the aortic valve and prosthetic valve implantation, resection of the ascending aorta, and interposition of a 22 mm Hamashied tubular vascular graft.At a follow-up visit 6 years later, the patient reported being easily fatigued and having palpitations. He had been suffering from hemolytic anemia and mild renal function impairment. Cardiac catheterisation and angiography showed a 40 mmHg gradient due to kinking of the aortic graft and no gradient at the coarctation site. We postulated the kinking of the aortic vascular graft may be related to an inappropriate vascular graft length. We also thought that the severe hemolysis was attributable to the disturbance of blood flow by a jet of blood at the site of the kinking aortic vascular graft. A second operation was performed because the renal function of the patient had decreased progressively and hemolysis symptoms increased. After the second operation, hemolysis on peripheral blood smears had disappeared and renal function had shown progressive improvements. (Int Heart J 2005; 46: 1123-1131

Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature

“…To date, 30 cases of hemolytic anemia secondary to aortoplasty have been reported in the English literature (Table 2). 6–28 The reported mechanisms included aortic graft stenosis (50%), graft kinking (23%), external compression of the graft (20%), and a folded elephant trunk appendage (7%). Graft stenosis was largely attributed to the inversion of Teflon strips; however, other cases involving implant narrowing secondary to graft dehiscence or dissection flap obstruction at the distal anastomosis have been reported.…”

Hemolytic anemia caused by aortic flap and inversion of felt strip after ascending aorta replacement

“…Hemolysis after cardiac surgery is a rare but recognized complication, especially as perivalvular leakage after prosthetic valve replacement. However, hemolysis related to an inner felt strip or a kinked prosthetic graft is very rare [ 1 – 7 ]. We described hemolytic anemia that developed at the site of an inverted Teflon felt strip after ascending aortic replacement.…”

Postoperative Early Hemolytic Anemia due to Inverted Teflon Felt Strip after Emergency Repair for Type A Dissection

“…2 Hepper et al mentioned that hemolysis developed 6 years later due to graft kinking caused by an inappropriate graft length. 4 Hori and colleagues presented a case of hemolytic anemia 4 years after surgery caused by graft compression due to a pseudoaneurysm arising from the proximal anastomosis. 5 As can be seen, these complications developed 4 to 8 years after surgery as these problems are usually associated with extravascular factors.…”