Unusual case of aortic coarctation complicated by mycotic pseudoaneurysm and bicuspid aortic valve endocarditis

Abstract

Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 26-year-old man suffered from this pathology. As the incidence of mycotic pseudo-aneurysm is very rare in patients with aortic coarctation, the choice of this pathology for a patient presenting with unexplained fever is the only way to reduce the mortality risk.

Bicuspid aortic valve with critical coarctation of the aorta: single- or two-stage operation?

“…In our center, we prefer using a bypass graft to avoid the neurological complications such as laryngeal nerve palsy or spinal cord ischemia, since the lesion is often long and complex in patients of BAV with CoA. However, the new single-stage procedure reported for such patients provides us another choice (8,12,19,21). During this operation, routine cardiopulmonary bypass is initiated, and the extra-anatomic bypass from the ascending aorta to the descending aorta is ideally anastomosed first to supply the descending aorta before cardioplegia is delivered.…”

“…The single-stage procedure commonly involved an extraanatomic bypass from the ascending aorta to the distal aorta of the narrow segment and other surgical repairs for cardiac defects (mainly aortic valve dysfunction) through a median sternotomy (8,12,19,21). In most cases, the extraanatomic bypass procedure was performed as soon as the cardiopulmonary bypass was initiated by cannulating the ascending aorta.…”

“…It may occur as either an isolated cardiac defect or in association with other congenital heart malformations (1,(3)(4)(5)(6)(7)(8)(9)(10). The most well-known anomaly associated with a BAV is aortopathy (1,(3)(4)(5)(6)(7)(8)(9)(11)(12)(13), which include coarctation of the aorta (CoA), aortic dissection, or aortic aneurysm. According to previous literatures, patients with BAV had a higher incidence of CoA than other aortic defects (14)(15)(16)(17), leading to increased morbidity and mortality (1,(14)(15)(16)(17)(18).…”

“…Because the simultaneous presence of a BAV and CoA involves both aortic valve disorders and aortic wall abnormalities, as well as other complex lesions in some patients, surgical treatment is conventionally performed in two stages: the critical CoA is managed first, and the abnormality of the aortic valve is addressed later. Recently, some cases who underwent single-stage procedure have been reported (12,(19)(20)(21)(22). However, we recently performed…”

An unexpected association in a patient with heart failure presenting a surgical challenge

“…Consequently, in patients with BAV a careful assessment of the valve, and also of the aortic root and the ascending aorta, should be performed . The most feared complication is aortic dissection, however, the actual incidence of this complication is low (4%) …”