Surgical treatment for isolated coarctation of the aorta in an adult patient

Abstract

A 51-year-old woman developed heart failure due to severe hypertension of the upper half of the body caused by coarctation of the aorta. From the available surgical options for this condition, we selected bypass grafting from the left subclavian artery to the descending aorta for this patient.

Selection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and Adults

“…7) Elkerdany et al also reported good outcomes in adults after the treatment of isolated CoA by left subclavian-aortic bypass. 17,18) This procedure avoids dissection through the hard adhesions between the CoA and surrounding organs; however, it cannot be used in the hypoplastic arch, and abnormal aortic wall remains.…”

“…21) In this procedure, proximal anastomosis is typically performed in the ascending thoracic aorta, but the appropriate site of distal anastomosis (abdominal aorta or descending thoracic aorta) is still under debate. 17,21,22) Patient No. 5 was treated by AVR with extra-anatomical bypass (ascending-descending aorta) in a single-stage repair.…”

Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling

“…If left untreated, COA carries dismal prognosis, several studies have shown an average survival age of 30–35 years, with a mortality rate of 75% by age 46 3 , 8 , 9 . The appropriate surgical technique for COA repair often remains unclear for adult patients 10 . Surgical techniques to treat COA include resection with end-to-end anastomosis, prosthetic patch aortoplasty, subclavian flap aortoplasty, interposition grafting and extra-anatomic bypass grafting 2 , 4 , 11 , 12 .…”

“…Extra-anatomical bypass grafting has been recommended for complex COA cases (COA coexists with the other valvular, vascular and ventricular diseases) 4 , 5 , 10 , 12 – 15 as well as isolated COA cases (COA does not coexist with the other cardiovascular pathologies) 11 , 12 in adults. Furthermore, surgical treatment for COA carries some risk for spinal cord injury, occurring in approximately 0.5% of patients being operated on for coarctation 16 , studies have shown that extra-anatomic bypass minimizes the risk of paraplegia 2 , 15 .…”