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.