R J Morris1, L E Samuels, S K Brockman. 1. Department of Cardiothoracic Surgery, Allegheny University of the Health Sciences-Hahnemann, Philadelphia, Pennsylvania 19102-1192, USA.
Abstract
BACKGROUND: Thoracic aortic coarctation accompanied by a second surgically reparable lesion is a rare combination in the adult patient. The simultaneous operative management of both lesions is desirable because of the higher morbidity and mortality that would occur with staged procedures. METHODS: We describe the simultaneous operative management in three adult patients with coarctation and a second cardiac lesion. All 3 patients had intrapericardial ascending aorta-descending aorta bypass and concomitant repair of a cardiac lesion. The attendant repairs in the 3 patients, respectively, were aortic valve replacement, orthotopic heart transplantation, and coronary artery bypass grafting. RESULTS: Double arterial cannulation, retrograde cardioplegia, large-bore aorto-aortic bypass grafts, and early use of alpha-agonists to stabilize systemic pressure were all key to ensuring safe conduct of the operation. Each patient had an essentially uneventful postoperative course. CONCLUSIONS: Thoracic coarctation and concomitant cardiac pathology can be safely and readily managed with a single-stage approach involving cardiac repair and extraanatomic ascending aorta-descending aorta bypass grafting. A review of the English-language literature of patients managed similarly is included.
BACKGROUND: Thoracic aortic coarctation accompanied by a second surgically reparable lesion is a rare combination in the adult patient. The simultaneous operative management of both lesions is desirable because of the higher morbidity and mortality that would occur with staged procedures. METHODS: We describe the simultaneous operative management in three adult patients with coarctation and a second cardiac lesion. All 3 patients had intrapericardial ascending aorta-descending aorta bypass and concomitant repair of a cardiac lesion. The attendant repairs in the 3 patients, respectively, were aortic valve replacement, orthotopic heart transplantation, and coronary artery bypass grafting. RESULTS: Double arterial cannulation, retrograde cardioplegia, large-bore aorto-aortic bypass grafts, and early use of alpha-agonists to stabilize systemic pressure were all key to ensuring safe conduct of the operation. Each patient had an essentially uneventful postoperative course. CONCLUSIONS: Thoracic coarctation and concomitant cardiac pathology can be safely and readily managed with a single-stage approach involving cardiac repair and extraanatomic ascending aorta-descending aorta bypass grafting. A review of the English-language literature of patients managed similarly is included.
Authors: Jose Rubio Alvarez; Laura Reija Lopez; Juan Sierra Quiroga; Jose M Martinez Comendador; Anxo Martinez-de-Alegria; Jose M Martinez Cereijo; Cristian Delgado Dominguez Journal: J Cardiothorac Surg Date: 2011-04-17 Impact factor: 1.637
Authors: Ju Hyun Park; Kook Jin Chun; Sung Gook Song; Jeong Su Kim; Yong Hyun Park; Jun Kim; Ki Seuk Choo; June Hong Kim; Sang Kwon Lee Journal: Korean Circ J Date: 2012-01-31 Impact factor: 3.243