Type A Aortic Dissection in a Patient With Congential Coarctation of the Aorta
Emergency Surgical Repair With an Extra-Anatomic Bypass
Congenital coarctation of the aorta was diagnosed in a 3-year-old boy with a systolic murmur, a brachial pressure of 130/95 mm Hg, and an ankle pressure of 75 mm Hg. Diagnosis was confirmed by echocardiography, which also showed a bicuspid aortic valve.
The parents, despite the advice of several pediatric cardiologists and cardiac surgeons, had always refused surgical correction or percutaneous angioplasty. In 1994, at the age of 13, the boy suddenly suffered an acute type A aortic dissection originating 2 cm distal from the aortic annulus and ending at the upper aortic arch that was associated with moderate aortic regurgitation. This critical situation prompted emergency intervention according to the Cooley procedure, with substitution of the ascending aorta and an extra-anatomic bypass, that connected the ascending with the abdominal aorta proximal to the celiac arteries (Figure 1). Recovery was rapid without functional sequelae and with normalization of the pressure gradient.
Despite optimal blood pressure control, a mild aortic valve insufficiency worsened, and a second cardiac intervention with aortic valve replacement was needed when the patient turned 18 years old. No early or late complications occurred after the extra-anatomic bypass (Movie). Late success is documented and highlighted by static and dynamic magnetic resonance angiography follow-up imaging that demonstrated normal patency and diameters of the grafts (Figure 2). Magnetic resonance imaging flow measurements in the extra-anatomic bypass and the native aorta are also documented (Figures 3 and 4⇓).
The Movie is available as an online-only Data Supplement at http://www.circulationaha.org.
↵*These authors contributed equally to the article.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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