Abstract
We presented a multimodal imaging approach to identifying aortic arch
aneurysm with a concurrent coarctation of the aorta in a 52-year-old
woman. We successfully adopted a new operative method and described the
management of whole process. The detailed imaging and intraoperative
data have not been reported in the literature before. This case
highlighted the feasibility and successful surgical intervention in a
patient with coarctation of the aorta and a concurrent enormous aortic
arch aneurysm. An extra-anatomical bypass is an innovative surgical
technique that is proved effective and beneficial.
Keywords: Congenital heart disease
A 52-year-old woman was admitted to our department with a high blood
pressure of 180/70 mmHg measured at the right upper limb, and at both
lower limbs, the blood pressure was lower, at 90/50 mmHg. The
transthoracic echocardiography revealed a bicuspid aortic valve,
moderate aortic valve regurgitation, coarctation of the aorta (COA), and
a huge aortic arch aneurysm in close proximity to the left common
carotid artery (Figure 1, panels A and B) .
Computed tomography was performed
which confirmed the diagnosis and demonstrated that the left subclavian
artery was originated from and deformed by the aneurysm(5.1×4.8cm) (Figure 1, panels C and D) . Given the findings,
surgery was carried out to correct abnormalities. The Bentall procedure
was performed to reconstruct the aortic valve and ascending aorta. A
22-mm Dacron graft was used to anastomose to the thoracic descending
aorta in an end-to-side fashion while the other end of the dacron graft
was anastomosed to the graft in Bentall procedure (Figure 1,
panels E and F) . Then, part of the aneurysm was excised and the left
subclavian artery was ligated.
Diffuse aortic dissection or medial degenerative disease involving the
entire aortic arch may result in the development of an exceedingly large
aneurysm.[1] On the other hand, COA is a
heterogeneous disorder affecting individuals of all age groups. Patients
with COA present with varying clinical symptoms, either in isolation or
in association with other cardiac defects.[2]Aortic arch aneurysm with a concomitant COA is a rare cardiac
malformation and remains a devastating disease associated with
underlying serious complications such as sepsis, coagulopathy, and
aneurysm rupture. In patients with COA, the outcome is poor without
surgical correction. The mean age of death was 34 years, with the
mortality rate reaching 75% at 43 years of
age.[3] Since the first surgical intervention for
correcting the COA described by Crafoord[4] in
1944, advancements have been made in surgical techniques to improve the
quality of treatment and the outcome of patients with this disorder.
Despite improvements in the mortality and morbidity rates, operations
for the COA continue to carry significant risks of adverse events or
patient morbidity. Concomitant aortic arch aneurysm combined with COA is
extremely rare. Therefore, individualized patient assessment and careful
plans for the most suitable treatment approach are required before on
embarking a high-risk surgery. Our case highlighted the feasibility and
successful surgical intervention in a patient with COA and a concurrent
enormous aortic arch aneurysm. An extra-anatomical bypass was performed
which proved beneficial in this case.