Coarctation Repair in an Adult Funambulist (Dombari)

Abstract

Five to seven percent of all congenital cardiac disorders are caused by aortic coarctation. Funambulism or tight rope walking is a part of street circus acts earning livelihood for Dombari community, which requires utmost upper and lower limb strength and balance. Coarctation can be repaired surgically or with interventional approach. End-to-end anastomosis, subclavian flap aortoplasty, and extra-anatomic bypass grafts are a few surgical fixes. However, these approaches are not without risks involving the subclavian artery and spinal arteries thus putting limbs in jeopardy. Interventional procedures include balloon angioplasty and use of bare metal or covered stents but are associated with complications like repeated interventions or surgery, migration of stents compromising branches of aorta, thereby causing limb paresis or plegia, and are not very cost effective. The authors hereby discuss a cost-effective surgical management and spinal protection strategy for coarctation in a funambulist patient.