Circulation. 2001;103:e92-e93
(Circulation. 2001;103:e92.)
© 2001 American Heart Association, Inc.
Images in Cardiovascular Medicine |
False Aneurysms of an Ascending-Aorta-to-Abdominal-Aorta Bypass for Coarctation of the Aorta
Arno A.W. Roest, MSc;
Martin N.J.M. Wasser, MD;
Michael I.M. Versteegh, MD;
Albert de Roos, MD;
Ernst E. van der Wall, MD;
Willem A. Helbing, MD;
Hubert W. Vliegen, MD
From the Departments of Pediatric Cardiology (A.A.W.R., W.A.H.),
Radiology (A.A.W.R., M.N.J.M.W., A.d.R.), Cardiology (A.A.W.R., E.E.v.d.W.,
H.W.V.), and Cardiothoracic Surgery (M.I.M.V.), Leiden University Medical
Center, Leiden, and the Interuniversity Cardiology Institute of the
Netherlands (A.A.W.R., A.d.R., E.E.v.d.W.), Utrecht, the Netherlands.
Correspondence to Arno A.W. Roest, MSc, Department of Pediatric Cardiology J6-S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail a.a.w.roest{at}lumc.nl
Our male
patient had a hypoplastic isthmus and a preductal coarctation of the
aorta. The coarctation was corrected by resection and end-to-end
anastomosis at the age of 3 months. The left subclavian artery was
sacrificed in this procedure. Thirteen years later, a recoarctation
involving the left carotid artery was diagnosed. Surgical correction
was achieved with a preclotted Dacron knitted graft, with a diameter of
2 cm, from the ascending aorta to the abdominal aorta. This bypass was
connected with the ascending aorta 5 cm above the aortic valve and
continued anterior to the heart over the right ventricle, passing the
diaphragm posterior to the left lobe of the liver, and was connected
end-to-side to the abdominal aorta just above the origin of the truncus
coeliacus. The native aortic arch and descending aorta were still
patent, but the descending aorta was hypoplastic.
A MRI scan was performed in 1986 when the patient was 18
years of age
(Figure 1
). In 1998, at the age of 30 years and 17 years
after placement of the Dacron bypass graft, the patient noticed leg
fatigue at exercise. Although normal pulsations were found in
the femoral arteries, a difference in blood pressure of 30 mm Hg
between the right arm and left leg was detected. Therefore, a MRI
examination was performed. The spin-echo image
(Figure 2) shows a dilatation in the abdominal part of the
bypass, with a maximal diameter of 8 cm. The maximum intensity
projection of a 3D, gadolinium-enhanced MR
angiogram1
(Figure 3) shows the site of the coarctation, the hypoplastic
descending aorta, and the Dacron bypass with its
dilatation.
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Figure 1. Sagittal spin-echo MRI image, obtained in 1986, of ascending-aorta-to-abdominal-aorta bypass 5 years after construction. No dilatation in any part of bypass was observed.
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Figure 2. Angulated sagittal spin-echo MRI image, obtained in 1998, of ascending-aorta-to-abdominal-aorta bypass 17 years after construction. In abdominal part of bypass, dilatation is observed (arrow). LV indicates left ventricle.
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Figure 3. Maximum intensity projection of a 3D, gadolinium-enhanced MR angiogram depicting site of coarctation, hypoplastic descending aorta, and Dacron bypass with its dilatation (*).
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At operation, the knitted graft was not dilated but
completely degenerated in its abdominal part, with several false
aneurysms surrounding it. The bypass was totally resected and
replaced.
References
1.
Prince MR,
Narasimham DL, Jacoby WT, et al. Three-dimensional gadolinium-enhanced
MR angiography of the thoracic aorta. AJR
Am J Roentgenol. 1996;166:1387–1397.[Abstract/Free Full Text]
