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

Abstract

Background: There are many reports on 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 dramatically improved after surgical treatment in a patient with progressive left ventricular dysfunction due to atypical coarctation of the aorta.Case presentation: A 58-year-old man underwent axilobifemoral 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 his 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 up to the renal arteries, 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 both renal arteries via a great saphenous vein grafts were performed. Postoperative blood pressure control improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography performed 1.5 years later showed improvement in contractility with a left ventricular ejection fraction of 58%. Conclusion: In patients with atypical coarctation of the aorta and 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.