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(Circulation. 2001;104:620.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Rotational Aortogram With Three-Dimensional Reconstruction in a Case of Repaired Aortic Coarctation

Fernando Boccalandro, MD; Bernardo De La Guardia, MD; Richard W. Smalling, MD, PhD

From the Division of Cardiology, Department of Internal Medicine, University of Texas Medical School, Houston, Tex.

Correspondence to Fernando Boccalandro, MD, Division of Cardiology, Department of Internal Medicine, University of Texas Medical School, 6431 Fannin St, MSB 1.246, Houston, TX 77030. E-mail fernando.boccalandro@uth.tmc.edu

A 54-year-old white woman with a history of hypertension, hyperlipidemia, atrial fibrillation, bicuspid aortic valve, and a previously repaired aortic coarctation in adulthood underwent a computed tomography (CT) scan of the chest to evaluate her surgical repair after an episode of chest pain. Her original repair consisted of a coarctectomy with placement of a side-to-side graft. The CT scan revealed a 4-cm, proximal descending thoracic aortic aneurysm in the repaired portion of the aorta. Magnetic resonance angiography (MRA) and a conventional aortogram did not clarify the underlying problem. She was referred to our center for further investigation and possible surgical or endovascular repair.

We performed a rotational aortogram with 3D reconstruction to solve the anatomic enigma (Figure). The study showed a prosthetic graft placed at the site of the coarctectomy, between the midportion of the aortic arch and the descending thoracic aorta, with the left subclavian artery and left carotid artery reimplanted into the proximal portion of the graft. Two aortic stumps left from the previous surgical repair were visualized. One smaller stump was located at the proximal end-to-side anastomosis of the graft with the aortic arch. A larger distal stump was located adjacent to the distal end-to-side anastomosis of the prosthetic graft with the descending thoracic aorta. The distal aortic stump and the graft were very close together, giving the impression of a dilatation in the repaired portion of the proximal descending aorta on the CT and MRA scans. The diameter of the graft and the distal . . . [Full Text of this Article]

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