Discussion
COA is a common congenital cardiovascular malformation. It has been
reported in the literature that 90% patients of untreated coarctation
die within 50 years, usually due to heart failure, coronary artery
disease, aortic dissection or rupture, infective endocarditis, or
cerebral hemorrhage [1].COA is usually isolated, but it may be
complicated with other major concomitant intra-cardiac anomalies.
Patients with Taussig-Bing deformity are prone to accompany with
coarctation and should be managed in surgical correction in a
single-stage operation. In this
case, coarctation had been undiagnosed before the previous operation
until that the giant aortic root aneurysm and significant aortic valve
insufficiency has developed.
The most common incision for repair of coarctation is left thoracotomy.
However, for this patient, ascending-descending aortic bypass which was
first reported by Edie and colleagues may be the best and safest
procedure [2]. Firstly, it can be done through a median sternotomy
allows for concomitant aortic valve and root procedures in a
single-stage operation. Secondly, extensive dissection can be avoided so
that the risks of massive hemorrhage, injury of phrenic, recurrent
laryngeal nerve and spinal cord ischemia would be limited [3].
Furthermore, although the patient was only 10-year old, the body size
was approximate to an adult’s, 20mm graft can provide adequate flow
during adulthood. What is different from previous surgeries is that the
artificial graft of this patient was placed on the left side of the
heart. In order to minimally compress the left ventricle, and for the
consideration of future growth, we placed the artificial graft in the
left thoracic cavity with sufficient length. The difference was mainly
because that the ascending aorta was posterior to the left after Switch
procedure.
Aortic dilation in COA is well documented, and this disorder is
associated with ascending aortic medial degeneration. In addition,
aortic dilation is a well-known complication after the switch procedure.
Aortic root and aortic valve surgery after Switch procedure occur in
approximately 2% of patients at 10 years [4]. These two reasons
contributed to the aortic root aneurysm and aortic valve insufficiency.
At operation, it was found that the aortic valve could not be repaired,
so Bentall procedure which involves replacement of aortic valve and
ascending aorta was the optimal strategy.
Funding : None.
Conflict of Interest : The authors declare that there are no
conflict of interests.
Data Availability Statement : All data used during the study
appear in the submitted article.