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Different strategies for simultaneous repair of aortic coarctation and associated cardiac diseases in adult patients

Jignesh Kothari, Bhavin Brahmbhatt, Kinnaresh Baria, Jigar Patel.

Background: Coarctation of aorta and associated cardiac disease is complex medical situation. Both requires correction either simultaneous or in stages. A distinct approach is vital in order to bring down the perioperative mortality and morbidity.

Objective: To study the different strategies for simultaneous repair of aortic coarctation and associated cardiac diseases in adult patients.

Materials and Methods: We have operated three patients with coarctation associated with other cardiac diseases, who were treated by various surgical approaches. Developments in endovascular technology over the past decade may potentially reduce the morbidity from open surgical repair. However, some cases are unsuitable for endovascular repair, and open surgical techniques continue to play a part in the management of these patients. Coarctation and associated diseases were treated in a single stage by an ascending-to-descending bypass (n = 2). One patient underwent a two-stage operation for his treatment.

Result: Postoperative recovery of all the three patients was uneventful. Their ICU parameters were within acceptable limits. All the three patients showed negligible gradients of blood pressure between the upper and lower extremities and discharged within 8 to 9 days. They showed postoperative CTscan suggestive of normal functioning graft without any leak or aneurysm.

Conclusion: In spite of the progress in the development and popularization of endovascular techniques, surgical intervention is becoming a more preferable option for the treatment of coarctation accompanied by cardiac diseases. Two-stage and single-stage (extra-anatomical bypass) procedures are the alternative techniques that are performed depending upon the experience of the surgeons in the center; however, we prefer the single-stage (simultaneous) technique.

Key words: Cardiopulmonary bypass, descending thoracic aorta, noncoronary sinus aneurysm

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American Journal of Diagnostic Imaging


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