1/135. Transdiaphragmatic graft replacement for coarctation suprarenal abdominal aorta.A 17-year-old boy was referred to us with severe hypertension, headache and intermittent lower extremity claudication. Approximately 3 months prior to admission, he began to experience headache and pain in the posterior aspect of the right thigh and calf upon walking only 20 m. Occasionally, similar symptoms developed in the left leg which were nearly always of the same intensity as on the right. Arterial blood pressure on admission to our hospital was 220/140 mmHg in the arm. After physical examination and diagnostic tests, he was operated on with the diagnosis of coarctation of the abdominal aorta. The purpose of this paper is to report on a patient having an area of coarctation just above the level of renal arteries who presented with severe hypertension and intermittent claudication and in whom there was complete relief of signs and symptoms after appropriate surgical intervention.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
2/135. A single-stage operation for bicuspid aortic valve, annulo-aortic ectasia, hypoplastic aortic arch, and coarctation of the aorta: A case report.The patient was an 18-year-old man who had been diagnosed as having a bicuspid aortic valve and dilatation of the ascending aorta six years previously. As he grew up, aneurysmal change of the ascending aorta and hypertension in the upper body gradually progressed. Preoperative evaluation showed annulo-aortic ectasia and the following congenital abnormalities: bicuspid aortic valve, hypoplastic aortic arch, and coarctation of the aorta. Composite graft replacement and extended total aortic arch replacement were carried out.- - - - - - - - - - ranking = 0.5keywords = hypertension (Clic here for more details about this article) |
3/135. Axillofemoral bypass for recurrent atypical coarctation of the thoracic aorta. Woman in childbearing age.Various surgical techniques for recurrent atypical coarctation have been described, and extra-anatomic bypass with a thoracotomy or a sternotomy approach has been widely recommended. We report a case where axillofemoral bypass has been used to treat a 28-year-old woman with recurrent atypical coarctation. Ordinarily, she had not suffered greatly from hypertension, but she experienced repeated miscarriages most probably owing to uncontrolled hypertension over 200 mmHg during pregnancy. We chose an axillofemoral bypass for extra-anatomic bypass to manage intractable hypertension during pregnancy. Postoperatively, her hemodynamics improved substantially, particularly during pregnancy, and two children were successfully delivered. The patient remains in excellent condition 74 months after operation. We suggest that an axillofemoral bypass will become an option among surgical techniques for recurrent coarctation under individual circumstances.- - - - - - - - - - ranking = 1.5keywords = hypertension (Clic here for more details about this article) |
4/135. Abdominal aortic coarctation with splanchnic arterial occlusion.Abdominal aortic coarctation is found in only 2% of aortic coarctation and is usually manifested by renovascular hypertension. Splanchnic arterial occlusive lesions occur in 22% of these patients and are exceptionally symptomatic. We present a case report of a young patient with abdominal aortic coarctation causing hypertension and visceral angina. The aetiopathogeny and treatment are discussed.- - - - - - - - - - ranking = 1.6830869474257keywords = renovascular, hypertension (Clic here for more details about this article) |
5/135. pregnancy and delivery in young woman affected by isthmic coarctation of the aorta.Coarctation of aorta is a rare cause of hypertension in pregnancy and the case material reported in literature is limited without a univocal line of clinical conduct. A case association between isthmic coarctation of the aorta and pregnancy in a 17 year-old primigravida woman is described.- - - - - - - - - - ranking = 0.5keywords = hypertension (Clic here for more details about this article) |
6/135. Atypical aortic coarctation with resistant hypertension treated with axilloiliac artery bypass.A 68-year-old woman was found to have atypical coarctation of the aorta, accompanied by systolic hypertension of the upper extremities despite administration of five types of antihypertensive drugs. Since the systolic hypertension was resistant to the conventional antihypertensive therapy, axilloiliac artery bypass grafting with a subcutaneous tunnel was performed to alleviate the pressure gradient. Systolic blood pressure was successfully reduced and hypertension was controlled after surgery.- - - - - - - - - - ranking = 3.5keywords = hypertension (Clic here for more details about this article) |
7/135. Abdominal coarctation and alagille syndrome.Structural cardiac defects such as peripheral pulmonary stenosis are well-described in alagille syndrome (AS), which is transmitted in an autosomal dominant inheritance. The genetic defect, with incomplete penetrance and variable expression, is localized to the short arm of chromosome 20. Abdominal coarctation is an uncommon congenital anomaly, with a spectrum of symptoms that may range from hypertension, intermittent claudication to abdominal pain. The association of abdominal coarctation with AS is rarely described. We report such a patient who also had aberrations of the visceral vascular supply involving the celiac, splenic, and superior mesenteric arteries. The indications to treat the coarctation, and in the context of a patient with AS, in whom liver transplantation may be contemplated at some stage, merit discussion.- - - - - - - - - - ranking = 0.5keywords = hypertension (Clic here for more details about this article) |
8/135. Left cervical aortic arch with aortic coarctation and saccular aneurysm.Cervical aortic arch is a very rare malformation and is occasionally accompanied by other cardiovascular anomalies. A 48-year-old male patient had a left cervical aortic arch with aortic coarctation and saccular aneurysm distal to the coarcted segment. The major clinical manifestations were upper body hypertension with a 50-mmHg discrepancy between the upper and lower limbs and a loud continuous murmur in the upper chest and back. magnetic resonance angiography successfully depicted the anomalous aorta, and the aortic coarctation and aneurysm were surgically resected and the thoracic aorta was reconstructed. The discrepancy in blood pressure diminished after the operation, but antihypertensive medication was continued to satisfactorily control the hypertension.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
9/135. Surgical treatment for graft stenosis after repair of an interrupted aortic arch: report of two cases.We report herein two cases of patients who underwent successful reoperation for graft stenosis after repair of an interrupted aortic arch (IAA). The first patient was a 10-year-old girl who suffered from upper limb hypertension 9 years after her initial operation. cardiac catheterization revealed a pressure gradient of 55 mmHg across the repaired arch. At reoperation, a left subclavian turndown anastomosis was performed, following which the hypertension resolved and a cardiac catheterization done 5 years later demonstrated sufficient growth of the restored arch with no significant gradient. The second patient was a 17-year-old boy who suffered from general fatigue and intermittent hypertension 12 years after his initial operation. cardiac catheterization revealed a gradient of 60 mmHg across the repaired arch. He underwent an extraanatomic ascending to descending aortic bypass employing an additional 18-mm graft, and a postoperative cardiac catheterization showed no gradient between the ascending and descending aorta. Our experience has shown that IAA should be repaired without prosthetic grafts if possible. Although extraanatomic bypass is useful for reducing the operative risks at reoperation, a large graft should be used to avoid the need for a third operation. For young children expected to outgrow a second graft, performing an endogenous anastomosis, such as a left subclavian turndown anastomosis, should be considered as an alternative.- - - - - - - - - - ranking = 1.5keywords = hypertension (Clic here for more details about this article) |
10/135. hypertension in the young adult--come feel the pulse.hypertension occurring in teenagers and young adults is uncommon. Though the most common form is still essential hypertension, secondary causes are more commonly found here than in older adults. Renal, cardiovascular and endocrine diseases constitute most of these causes. Coarctation of the aorta is the most common cardiovascular cause of hypertension, and its importance lies in the fact that it is correctable, and that its persistence often leads to dangerous complications and early death. The cardinal sign of differential pulse and blood pressures between the upper and lower limbs can be detected clinically. Hence, the importance of a detailed physical examination in all young hypertensives, including palpation of all the pulses, cannot be overemphasized. We present 2 hypertensive young men who were found to have isolated coarctation of the aorta.The lesion in the first patient was located postductally just distal to the left subclavian artery.This area has been found to be the most common site of coarctation.The second patient had an unusual mid-thoracic coarctation. The clinical and radiological features as well as complications are highlighted. In young hypertensive patients, a high index of suspicion may enable the physician to make a timely diagnosis and hence avert the potentially disastrous complications that may arise in undetected cases.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
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