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• W3194729305 abstract "HomeCirculation: Cardiovascular ImagingVol. 14, No. 10Surgical Intervention of a Rare Case of Complex Coarctation of Descending Aorta Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBSurgical Intervention of a Rare Case of Complex Coarctation of Descending Aorta Hechen Shen, MD, Yan Yun, MD, Junjie Huang, BS, Zheng Zheng, BS, Diming Zhao, MD, Shanghao Chen, MD, Shijie Zhang, MD, Zezhong Wu, MD, Chengwei Zou, MD, Haizhou Zhang, MD and Xiaochun Ma, MD, PhD Hechen ShenHechen Shen Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). *H. Shen, Y. Yun, J. Huang, and Z. Zheng contributed equally. Search for more papers by this author , Yan YunYan Yun Department of Radiology, Qilu Hospital of Shandong University, Jinan, China (Y.Y.). *H. Shen, Y. Yun, J. Huang, and Z. Zheng contributed equally. Search for more papers by this author , Junjie HuangJunjie Huang Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). *H. Shen, Y. Yun, J. Huang, and Z. Zheng contributed equally. Search for more papers by this author , Zheng ZhengZheng Zheng Shandong Provincial Hospital affiliated to Shandong University and Shandong First Medical University, Jinan, China (Z.Z.). *H. Shen, Y. Yun, J. Huang, and Z. Zheng contributed equally. Search for more papers by this author , Diming ZhaoDiming Zhao Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author , Shanghao ChenShanghao Chen Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author , Shijie ZhangShijie Zhang Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author , Zezhong WuZezhong Wu https://orcid.org/0000-0003-0688-7469 Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author , Chengwei ZouChengwei Zou Chengwei Zou, MD, Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324 Jingwu Rd, Jinan, Shandong 250021, China, Email E-mail Address: [email protected]. Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author , Haizhou ZhangHaizhou Zhang Haizhou Zhang, MD, Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324 Jingwu Rd, Jinan, Shandong 250021, China, Email E-mail Address: [email protected] Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author and Xiaochun MaXiaochun Ma Correspondence to: Xiaochun Ma, MD, PhD, Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324 Jingwu Rd, Jinan, Shandong 250021, China, Email E-mail Address: [email protected] https://orcid.org/0000-0003-1055-4691 Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (H.S., J.H., D.Z., S.C., S.Z., Z.W., C.Z., H.Z., X.M.). Search for more papers by this author Originally published27 Aug 2021https://doi.org/10.1161/CIRCIMAGING.121.013010Circulation: Cardiovascular Imaging. 2021;14:e013010Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 27, 2021: Ahead of Print A 15-year-old female patient was hospitalized with a chief complaint of paroxysmal muscle weakness and headache for 2 years. She had a history of open-heart surgery for ventricular septal defect and patent ductus arteriosus at 2 years old. The patient manifested a high blood pressure of right upper limb (155/81 mm Hg) and weak left brachial and femoral artery pulses (left upper limb: 84/46 mm Hg; right lower limb: 70/51 mm Hg; left lower limb: 76/38 mm Hg). The physical examination detected a grade III/VI systolic murmur at the left sternal margin. The preoperative transthoracic echocardiography and aortic computed tomography angiography confirmed a rare anatomic malformation of aortic arch and descending aorta including cervical aortic arch, coarctation of descending aorta as well as dysplasia of aortic arch and left subclavian artery (Figure 1).Download figureDownload PowerPointFigure 1. The preoperative transthoracic echocardiography (TTE) and aortic computed tomography angiography (CTA). The aortic CTA (A–C) showed the anatomic malformation of the aortic arch and descending aorta including cervical aortic arch (asterisk), coarctation of descending aorta (large arrow), as well as hypoplasia of aortic arch and left subclavian artery (small arrow). The preoperative TTE revealed the abnormal blood flow through the tortuous transverse arch (D) and coarctation of descending aorta (E).The surgical procedure was performed under general anesthesia, and the cardiopulmonary bypass was established via the femoral artery and vein. A left posterior lateral thoracotomy approach through fourth to fifth intercostal space provided excellent exposure for diseased aortic arch and descending aorta. The wall of aortic arch distal to left carotid artery was thin and left hemi-arch was tortuous in a “S” shape, and the descending aorta distal to the arterial ligament was evidently narrow. The aortic arch was cross-clamped between the innominate artery and the left common carotid artery, as were the left common carotid artery and the left subclavian artery. A 16 mm MAQUET vascular graft was connected to the aortic arch at the orifice of left common carotid artery and to the descending aorta 3 cm distal to the arterial ligament by end-to-end anastomosis. The left subclavian artery was sutured to the graft by end-to-side anastomosis. A postoperative aortic computed tomography angiography reexamination showed the formation of a pseudoaneurysm at the site of anastomosis between the graft and descending aorta (Figure 2). Then a covered stent was implanted to eliminate the pseudoaneurysm (Figure 3). The patient experienced an uneventful recovery before discharge.Download figureDownload PowerPointFigure 2. The postoperative transthoracic echocardiography (TTE) and aortic computed tomography angiography (CTA). The postoperative TTE demonstrated the corrected blood flow of descending aorta (A) and aortic arch (B). The postoperative aortic CTA (C–E) detected the formation of a pseudoaneurysm (arrow).Download figureDownload PowerPointFigure 3. The aortic computed tomography angiography (CTA) after the endovascular procedure and follow-up transthoracic echocardiography (TTE). The aortic CTA (A–C) showed the covered stent (arrow) has eliminated the pseudoaneurysm. The follow-up TTE (D) one month after discharge detected no abnormal blood flow.Coarctation of the aorta (CoA) accounts for 5% to 8% of all congenital cardiovascular diseases, and it frequently accompanies with several other cardiovascular anomalies, such as ventricular septal defect, patent ductus arteriosus, and aortic arch hypoplasia.1 Prenatal diagnosis of CoA is still challenging, despite echocardiographic screening.2,3 Transthoracic echocardiography is the primary imaging modality for diagnosis of CoA, and aortic computed tomography angiography is preferred for further noninvasive diagnosis and follow-up. Mean survival of unoperated patients is <35 years. Therefore, timely diagnosis and early treatment of CoA is crucial for an improved prognosis. Surgical and endovascular strategies have been reported for CoA. In older children and adults, endovascular treatment is the treatment of choice whereas a hybrid procedure is more suitable for complex CoA.4 Here, we presented a rare case of complex coarctation of descending aorta in the presence of cervical aortic arch as well as dysplasia of aortic arch and left subclavian artery in a 15-year-old female. Endovascular treatment would be infeasible given the tortuous transverse aortic arch. A combined surgical and endovascular procedure was performed to restore the anatomy of aortic arch and descending aorta.Sources of FundingThe current work was supported by grants from National Natural Science Foundation of China (81800255), the National Nature Science Foundation of Shandong Province (ZR2020MH044 to Dr Zou) and Natural Science Foundation of Shandong Province (ZR2018BH002 to Dr Ma).DisclosuresNone.Footnotes*H. Shen, Y. Yun, J. Huang, and Z. Zheng contributed equally.For Sources of Funding and Disclosures, see page 1004.Correspondence to: Xiaochun Ma, MD, PhD, Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324 Jingwu Rd, Jinan, Shandong 250021, China, Email [email protected]comHaizhou Zhang, MD, Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324 Jingwu Rd, Jinan, Shandong 250021, China, Email [email protected]comChengwei Zou, MD, Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No.324 Jingwu Rd, Jinan, Shandong 250021, China, Email [email protected]edu.cn.References1. Dijkema Elles J, Leiner Tim, Grotenhuis Heynric B. Diagnosis, imaging and clinical management of aortic coarctation.Heart. 2017; 103: 1148–1155. doi: 10.1136/heartjnl-2017-311173CrossrefMedlineGoogle Scholar2. Jowett V, Aparicio P, Santhakumaran S, Seale A, Jicinska H, Gardiner HM. Sonographic predictors of surgery in fetal coarctation of the aorta.Ultrasound Obstet Gynecol. 2012; 40:47–54. doi: 10.1002/uog.11161CrossrefMedlineGoogle Scholar3. Liberman RF, Getz KD, Lin AE, Higgins CA, Sekhavat S, Markenson GR, Anderka M. Delayed diagnosis of critical congenital heart defects: trends and associated factors.Pediatrics. 2014; 134:e373–e381. doi: 10.1542/peds.2013-3949CrossrefMedlineGoogle Scholar4. Wang R, Sun LZ, Hu XP, Ma WG, Chang Q, Zhu JM, Liu YM, Yu CT. Treatment of complex coarctation and coarctation with cardiac lesions using extra-anatomic aortic bypass.J Vasc Surg. 2010; 51:1203–1208. doi: 10.1016/j.jvs.2009.12.027CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails October 2021Vol 14, Issue 10 Article InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.121.013010PMID: 34445888 Originally publishedAugust 27, 2021 Keywordsthoracotomyfemoral arterysubclavian arterystentscardiovascular diseasePDF download Advertisement SubjectsCardiovascular SurgeryCongenital Heart DiseaseStent" @default.
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