Abstract
The authors describe the operative technique approach and its post-operative course used in an adult patient with coarctation of aorta, in which it was not possible to perform the traditional correction with an end-to-end anastomosis with graft interposition. During the surgery it was necessary to make an extra-anatomic bypass: ascending-descending aorta with an enlarged left posterior-lateral thoracotomy approach. The authors also make a short review of several possible approaches used for extra-anatomic bypass as well as its advantages and drawbacks.
Highlights
The first surgery for repair of coarctation of the aorta (CoAo) was performed over 50 years ago, we often face complex cases turning traditional approaches impossible or very risky.The traditional techniques for repair of coarctation of the aorta are resection of the narrowed area and end-toend anastomosis, with or without graft interposition; aorta surgically repaired by grafting a homograft “shaped like a Spanish roofing tile” in the narrowed area; and subclavian “flap” angioplasty
The term complex CoAo refers to those cases in which associated heart lesions are present and repair surgery is required, long narrowed route, hypoplastic aortic arch, and a very poor collateral circulation at the coarctation region
It has been proposed a single approach via median sternotomy with an extra-anatomic ascending aorta-to-descending thoracic aorta bypass
Summary
The first surgery for repair of coarctation of the aorta (CoAo) was performed over 50 years ago, we often face complex cases turning traditional approaches impossible or very risky.The traditional techniques for repair of coarctation of the aorta are resection of the narrowed area and end-toend anastomosis, with or without graft interposition; aorta surgically repaired by grafting a homograft “shaped like a Spanish roofing tile” in the narrowed area; and subclavian “flap” angioplasty. CARVALHO, MVH ET AL - Aortic coarctation in the adult: regarding a case and extra-anatomic bypass approaches The first surgery for repair of coarctation of the aorta (CoAo) was performed over 50 years ago, we often face complex cases turning traditional approaches impossible or very risky.
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