Two Staged Surgical Treatment of Aortic Coarctation Accompanied by Aortic Stenosis in a 63-Year-Old Patient

Öz

Aortic coarctation is a congenital vascular lesion, usually diagnosed and corrected in childhood or early adulthood. Most of the untreated patients with aortic coarctation die before the age of 50 years. Coarctation with cardiac lesions is a complex clinical situation that necessitates surgical treatment of different pathologies with different strategies. In this, study we report two-staged surgical treatment of aortic coarctation with severe aortic stenosis consist of aortic valve replacement and aorto-subclavian bypass in a 63-year-old male patient.

Anahtar Kelimeler

• Aortic coarctation
• aortic valve replacement
• congenital heart disease

63 Yaşındaki Hastada Aort Stenozunun Eşlik Ettiği Aort Koarktasyonunun İki Aşamalı Cerrahi Tedavisi

Öz

Aort koarktasyonu genellikle çocuklukta ve ergenliğin erken dönemlerinde teşhis edilen ve düzeltilen konjenitalvasküler bir lezyondur. Aort koarktasyonu olan ve tedavi edilmeyen hastaların çoğu 50 yaşından önce ölür. Koarktasyonun, kardiyak lezyonlarla birliktelik gösterdiği durumlar, farklı patolojilerin farklı stratejilerle cerrahi tedavisini gerektiren karmaşık bir klinik durumdur. Bu çalışmada 63 yaşındaki erkek hastada ciddi aort stenozunun eşlik ettiği aort koarktasyonunun, aort kapak replasmanı ve aorto-subklaviyan baypastan oluşan iki aşamalı cerrahi tedavisini sunduk.

Anahtar Kelimeler

• Aort koarktasyonu
• aort kapak replasmanı
• konjenital kalp hastalığı

Kaynakça

1. Holzer R, Quershi S, Ghasemi A, Vincent J, Sievert H, Gruenstein D, et al. Stenting of aortic coarctation: Acute, intermediate, and long-term results of a prospective muti-institutional registry- Congenital cardiovascular interventional study consortium (CCISC). Catheterization & Cardiovascular Interventions. 2010; 76(4): 553-563. doi:10.1002/ccd.22587
2. Duran NE, Korkmaz Y, Kurt FB, Yilmazer SM, Cingozbay BY. Aort Coarctation. Maltepe Med J. 2014; 6(3): 1-5.
3. Yu Z, Wu S, Li C, Zou Y, Ma L. One stage surgical treatment of aortic valve disease and aortic coarctation with aortic bypass grafting through the diaphragm and aortic valve replacement. J Cardiothorac Surg. 2015; 10: 160-167. doi:10.1186/s13019-015-0338-2
4. Ugur M, Alp I, Arslan G, Temizkan V, Ucak A, Yilmaz AT. Four different strategies for repair of aortic coarctation accompanied by cardiac lesions. Interact CardiovascThorac Surg. 2013; 17(3): 467-471. doi:10.1093/icvts/ivt242
5. Koletsis E, Ekonomidis S, Panagopoulos N, Tsaousis G, Crockett J, Panagiotou M. Two stage hybrid approach for complex aortic coarctation repair. J Cardiothorac Surg. 2009; 4: 10-18. doi:10.1186/1749-8090-4-10
6. Alvarez JR, Lopez LR, Quiroga JS, Comendador JM, Alegria A, Cereijo JM, Dominguez CD. Internal mammary artery dilatation in a patient with aortic coarctation, aortic stenosis, and coronary disease: Case report. J Cardiothorac Surg. 2011; 6: 55-62. doi:10.1186/1749-8090-6-55
7. Campbell M. Natural history of coarctation of the aorta. Br Heart J. 1970;32:633-640. doi:10.1136/hrt.52.5.633
8. Park JH, Chun KJ, Song SG, Kim JS, Park YH, Kim J, et al. Severe Aortic Coarctation in a 75-Year-Old Woman: Total Simultaneous Repair of Aortic Coarctation and Severe Aortic Stenosis. Korean Circ J. 2012; 42(1): 62-64. doi:10.4070/kcj.2012.42.1.62

9. Refatllari A, Likaj E, Dumani S. Prosthetic Subclavian-Aortic Bypass as a Safe Surgical Technique for the Coarctation of the Aorta in Adults. Macedonian Journal of Medical Sciences. 2016; 4(1): 47-49. doi:10.3889/oamjms.2016.006
10. Brouwer RM, Erasmus ME, Ebels T, Eijelaar A. Influence of age on survival, late hypertension and recoarctation in elective aortic coarctation repair. J ThoracCardiovasc Surg. 1994; 108: 525-531. PMID:8078345
11. Jashari H, Rydberg A, Ibrahimi P, Bajraktari G, Henein MY. Left ventricular response to afterload in children; Aortic stenosis and coarctation: A systematic review of the current evidence. Int J Cardiol. 2015; 198: 203-209. doi:10.1016/j.ijcard.2014.10.089
12. Mulay AV, Ashraf S, Watterson KG. Two-stage repair of adult coarctation of the aorta with congenital valvular lesions. Ann Thorac Surg. 1997; 64: 1309-11. doi:10.1016/s0003-4975(97)00814-X
13. Singh S, Hakim FA, Sharma A, Roy R, Panse PM, Chandrasekaran K, et al. Hypoplasia, Pseudocoarctation and Coarctation of the Aorta- ASystematic Review. Heart, Lung and Circulation. 2015;24(2):110-118. doi:10.1016/j.hcl.2014.08.006
14. McLennan D, Caputo M, Talitolis D. Severe Aortic Stenosis and Severe Coarctation of the Aorta: A Hybrid Approach to Treatment. Front Surg. 2017;4:16-19. doi:10.3389/fsurg.2017.00016