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Case Reports
. 2024 Sep 15;16(9):e69444.
doi: 10.7759/cureus.69444. eCollection 2024 Sep.

Extra-anatomical Bypass in a Case of Recoarctation and Previous Cardiac Surgery

Assen Keltchev  1 , Kristiyanna Mavrodieva  1 , Andrey Neutov  1 , Evgeni V Mekov  2 , Georgi Yankov  2
Affiliations
Case Reports

Extra-anatomical Bypass in a Case of Recoarctation and Previous Cardiac Surgery

Assen Keltchev et al. Cureus. .

Abstract

A complex clinical case of aortic recoarctation is presented. The case is a 61-year-old comorbid patient with two previous aortic and cardiac operations. At the age of 10, the patient underwent surgery for post-ductal coarctation of the aorta (adult type) at the typical site, where the stenotic area was completely resected, and an end-to-end anastomosis was performed through a left-sided thoracotomy. Ten years ago, the patient also had mitral valve replacement with a metallic prosthesis due to severe mitral insufficiency, performed via median sternotomy. The patient was admitted to the cardiac surgery unit due to symptoms suggestive of aortic re-stenosis due to status post repair of coarctation of the aorta (resection with end-to-end anastomosis). An extra-anatomic bypass was performed between the ascending and abdominal aorta, with the graft passing through a new diaphragm opening in front of the hilus of the right lung.

Keywords: aortic recoarctation; aortic stenosis; cardiac surgery; extra-anatomic bypass; resternotomy.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative coronal computed tomography view of the patient.
Figure 2
Figure 2. Intraoperative view of the placed vascular prosthesis for the implementation of the extra-anatomical bypass between the ascending aorta and the abdominal aorta.
(A) View of the distal anastomosis from the laparotomy. (B) View of the proximal anastomosis from the sternotomy (in both images, left is patient's left, down is cephalic).
Figure 3
Figure 3. Postoperative X-ray of the patient.
Figure 4
Figure 4. Postoperative CT angiography demonstrating the patency of the extra-anatomic bypass.
(A) View of the distal anastomosis. (B) View of the proximal anastomosis.
See this image and copyright information in PMC

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