1/718. Reduced left ventricular dimension and normalized atrial natriuretic hormone level after repair of aortic coarctation in an adult. Although unusual in the older patient, coarctation of the aorta can be an occult cause of cardiomyopathy. This report describes a 53-year-old man with new-onset heart failure symptoms, global left ventricular (LV) dysfunction, and underlying aortic coarctation. Surgical correction resulted in reduced LV size, resolution of symptoms, and normalization of atrial natriuretic hormone levels. ( info) |
2/718. Cervical aortic arch with pseudocoarctation: presentation with spontaneous rupture. A 23-year-old man presented with hypotension secondary to a left hemothorax. Diagnostic studies revealed a left cervical arch associated with a redundant tortuous pseudocoarctation in the proximal descending thoracic aorta. Operative exploration revealed an aortic rupture just proximal to the pseudocoarctation. Resection of the diseased aorta and tube graft replacement was performed under circulatory arrest. The patient was discharged home on the 12th postoperative day. ( info) |
3/718. Bedside cardiac catheterization using transesophageal echocardiographic guidance. We describe for the first time the use of transesophageal echocardiography to guide cardiac catheterization performed at the bedside in the pediatric cardiac intensive care unit. The procedure was performed on a 2.6-kg infant with ventricular and atrial septal defects after repair of coarctation of the aorta. Poor hemodynamic status prevented obtaining the required hemodynamic information from cardiac catheterization in the cardiac catheterization laboratory. Transesophageal echocardiography provided cardiac and vascular imaging, which helped guide catheter placement where the small size of the infant and the extensive thoracic postoperative bandages prevented obtaining the echocardiographic information from other windows. ( info) |
4/718. Aortobronchial fistula after coarctation repair and blunt chest trauma. A 34-year-old man had development of an aortobronchial fistula 17 years after patch aortoplasty for correction of aortic coarctation and 5 years after blunt chest trauma, an unusual combination of predisposing factors. The clinical presentation, characterized by dysphonia and recurrent hemoptysis, and the surgical findings suggested the posttraumatic origin of the fistula, which was successfully managed by aortic resection and graft interposition under simple aortic cross-clamping, associated with partial pulmonary lobectomy. When hemoptysis occurs in a patient with a history of an aortic thoracic procedure, the presence of an aortobronchial fistula should be suspected. early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure. ( info) |
5/718. Complete interruption of the aorta in Noonan's syndrome. A patient is presented who lived to age 60 with complete interruption of the aorta associated with Noonan's syndrome. On chest x-ray there were calcified mediastinal masses and bilateral rib notching. angiography demonstrated complete interruption of the aorta with markedly dilated tortuous intercostal arteries. The roentgenographic studies are correlated with the surgical and pathological findings. Noonan's syndrome is discussed. ( info) |
6/718. Coarctation of the aorta with right aortic arch: surgical technique and new classification. BACKGROUND: The combination of right aortic arch and coarctation of the aorta has seldom been reported. This rare abnormality occurs as an isolated lesion or in association with other congenital defects, such as mixed gonadal dysgenesis and Turner's syndrome. methods: The medical records of 2 patients who underwent operation for right aortic arch and aortic coarctation in our institution were reviewed together with case reports in the literature. Various surgical options have been reported: synthetic grafts, subclavian flap, and end-to-end anastomosis. End-to-end anastomosis is our method of choice for coarctation of the aorta and for right aortic arch with coarctation, even though an excessive amount of dissection is needed. RESULTS: Both patients from our institution are doing well, with no sign of recoarctation in either patient. Our experience and recent advances in the understanding of the anatomy of this lesion led us to develop an alternative simplified classification for right aortic arch, which is presented here. CONCLUSIONS: Right aortic arch and coarctation of the aorta is a rare morphologic combination. On the basis of our experience with repair of coarctation of the aorta and our review of the literature, we think that end-to-end anastomosis is the operative technique of choice with the best long-term results. Our simplified classification is easy to understand when dealing with right aortic arch. ( info) |
7/718. Coarctation of the left pulmonary artery associated with congenitally corrected transposition. We describe an infant with congenitally corrected transposition, ventricular septal defect and severe pulmonary stenosis. The heart occupied a midline position. Extension of ductal tissue had resulted in occlusion of the left pulmonary artery. As far as we are aware, this is the first report of an association of coarctation of the left pulmonary artery with corrected transposition. ( info) |
8/718. Acquired thromboatheromatous coarctation of the aorta: acquired coarctation of the aorta. BACKGROUND: Atheromatosis of the thoracic aorta and aortic arch is a well established source of systemic embolism. Acquired atheromatous coarctation of the aortic arch is a rare finding and not well documentated so far. CASE REPORT AND FINDINGS: Two patients presenting with intermittent claudication of the lower extremities were identified as having thromboatheromatous coarctation of the aortic arch as visualized by magnetic resonance tomography, fast CT scan, transesophageal echocardiography, cardiac catheterization and aortography. All findings including invasive hemodynamics resembled congenital coarctation of the aorta. One patient was treated surgically, while the other refused surgery and received long-term anticoagulation. CONCLUSION: Atheromatosis of the thoracic aorta and aortic arch not only cause systemic embolism, but may lead to the clinical and hemodynamic picture of coarctation of the aortic arch. ( info) |
| Cardiac anomalies are usually diagnosed early in life, which is particularly true for their various combinations. The diagnosis in adulthood is rare. Here we report the case of a young man with an aortic coarctation corrected at the age of 16, however the associated stenotic bicuspid aortic valve and cor triatriatum sinistrum were corrected after streptococcus viridans endocarditis 7 years later. ( info) |
| The article describes the management of aortic coarctation associated with coronary artery disease by a one stage surgical procedure without cardiopulmonary bypass in a 44-year-old woman. The vascular prosthesis was anastomosed end-to-end to the descending aorta and a venous bypass was subsequently formed between circumflex coronary artery and the anastomosed vascular prosthesis. There were no postoperative complications. ( info) |