Visceral Ischemia Caused by Extra-Anatomical Bypass for Coral Reef Aorta

A 72-year-old woman was presented with intermittent claudication of bilateral lower extremities, refractory hypertension, and mild renal impairment. Computed tomographic angiography showed severe aortic stenosis caused by calcifications protruding into the aortic lumen proximal and distal to the visceral and renal branches, so-called coral reef aorta. An axillo-iliac bypass was performed. Postoperatively, the patient developed ileus and acute renal failure, presumably caused by a steal phenomenon to the lower extremities. Endovascular stenting of the aorta increased forward blood flow and dramatically improved the patient’s condition. This case study illustrates potential hemodynamic complications after extra-anatomical axillo-iliac bypass for coral reef aorta.

Extra-anatomic aortic bypass for treatment of atypical aortic coarctation

Background The conventional extra-anatomic bypass is originated from the axillary＇s artery and the graft size is often limited due to the small diameter of axillary＇s artery. ascending aorta can improve the graft size and distal perfusion, Extra-anatomic bypass graft originating from need sternotomy which might have higher operative risks compared with axillo-femeral bypass. We summarize our experiences of extra-anatomic bypass from ascending aorta for atypical aortic coarctation. Methods Between January 2005 and February 2008, 5 women aged from 18 to 64 years underwent extra-anatomic bypass from ascending aorta to abdominal aorta or iliac artery bypass for treatment of atypical aortic coarctation. Preoperatively, all patients had hypertension and needed antihypertensive medications. Systolic blood pressure was 151 ± 9 mmHg. Ankle pressure index （API） 0.23 in left and 0.56± 0.23 in right. Average systolic pressure gradient of aortic stenosis was 76 were 0.60 ± 18 mmHg. Three patients underwent concomitant cardiac operation, including coronary artery bypass grafting, Benta11 procedure and atrial septal defect repair. Results There was no hospital and late mortality during 58 ＋ 15 months follow-up （range from 44 to 81 months）. Postoperative systolic blood pressure was reduced to 126 ± 11 mmHg at the time of discharge. All patients maintained normal blood pressure without medication during follow-up. API was improved to 1.12 ± 0.24 in left and 1.17 ± 0.25 in right （compared with preoperative data, P 〈0.05）. Follow-up computer tomography showed patency in all grafts. Conclusions Surgical treatment of atypical aortic coarctation with extra-anatomic bypass originating from ascending aorta alleviates hypertension and low limb ischemia. IS Chin J Cardiol 2011; 12（4） ： 207-2113

Malposition of Stent a Rare Complication in Coarctation of Aorta Corrected with Extraanatomic Aortic Bypass

Mal-position of stent in coarctation of aorta is very rare but a major complication. Symptoms can worsen even more. We present here one such case where stenting done in some other institute in which we did an extra-anatomical bypass from ascending aorta to supracelial aorta successfully bypassing the coarct segment. This was an early approach without assistance of Cadio-pulmonary (CP) Bypass. We conclude that this procedure should be done in centres where experienced operator and cardiac surgery back up is present. This was a good approach without assistance of CP Bypass.

Single-Stage Repair of a Critical Aortic Coarctation, a Bicuspid Aortic Stenosis and an Ascending Aortic Aneurysm

We report a 26-year-old man with critical aortic coarctation, severe bicuspid aortic valve stenosis, infective endocarditis and ascending aortic aneurysm. He underwent simultaneously in singlestage a Bentall’s procedure and an extra-anatomic ascending-descending aortic bypass grafting by 14-mm Dacron tube, through median sternotomy. The immediate postoperative outcome was favourable. The CT scan control for 7 years after surgery showed a good patency of the extra-anatomic bypass.

Surgical correction of postductal aortic coarctation in 40 adolescents and adults： A ten-year single institution experience

Background In clinical practice, there are different surgical approaches for postductal coarctation of the aor- ta （CoA）, with their advantages and disadvantages. Limited studies have reported the surgical outcomes of post- ductal CoA in adolescents and adults. Methods From January 2005 to December 2014, a total of 40 patients aged over 14 years underwent surgical corrections of postductal CoA in our institution. The surgical outcomes as reflected by cardiac function and differences in mean blood pressure of upper and lower extremities both preoper- ative and postoperative were recorded and evaluated. Results Among the 40 patients underwent successful sur- gical corrections, 1 patient complicated by acute aortic dissection and died, while the remainings survived to hos- pital discharge. During the 12-36 month follow-up period, postoperative mean blood pressure differences of upper and lower extremities were significantly reduced as compared with the preoperative data. Postoperative evalu- ation of cardiac function was conducted in all patients with New York Heart Association （NYHA） Ⅰ-Ⅱ. Conclusion For adolescent and adult patients with postductal aortic coarctation, surgical correction is highly recom- mended. Surgical approach should be based on the specific anatomy of the coarctation lesion, concomitant mal- formations, and expected grown-up height. Those complicated with other intracardiac malformations should be treated with extra-anatomical bypass technique and simultaneous surgical correction of CoA, which is effective with desirable postoperative prognosis.