Surgery for Coarctation of the Aorta in an Adult – unusual occurence

Coarctation of the aorta is a congenital malformation of the aorta usually diagnosed and corrected early in life. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a report of surgery for coarctation of the aorta where a late diagnosis was made a 32-year-old male.

He had been apparently well until 2 months prior to his consultation with us at the heart and lung clinic.. He had earlier attended a pre-employment checkup where he was diagnosed to have uncontrolled hypertension. He was known to have hypertension for 5 years for which he was on medications. He came to us for further evaluation of his high blood pressure. He had no other co-morbidities.

Physical Examination in Coractation of the Aorta

Coarctation of the aortaPhysical examination revealed a blood pressure 170/90 mm Hg in both arms, a heart rate of 74 beats/minute and a continuous murmur in the interscapular region of the back. Femoral pulses were palpable bilaterally but weak and delayed compared to the brachial pulses.

His echocardiogram showed bicuspid aortic valve and mild (insignificant) mitral insufficiency. A cardiac silhouette at the upper limit of normal and notching of the ribs was observed on the chest radiography. His CT angiogram showed severe coarctation of aorta with well developed collaterals.

coarctation of the aortaSurgery for Coarctation of the Aorta

It was decided to correct the lesion by surgery (Thoracotomy and Interposition graft). The procedure was done via a left posterolateral thoracotomy through the fourth left intercostal space. Entry in to the thorax was difficult because of the presence of numerous collaterals. Bleeding from the collaterals had to be carefully controlled.

The narrowed segment of the aorta was resected and continuity of the thoracic aorta was restored using a collagen impregnated Dacron interposition graft. The aorta needed to be clamped for 23 minutes.

He was discharged from hospital after an uneventful postoperative hospital stay of 6 days. His blood pressure medications could be reduced substantially. A repeat CT angiogram just before his discharge showed normal luminal continuity of the thoracic aorta. He was selected for his job and is now gainfully employed.

Discussion.

Coarctation of the aorta is a congenital (present from birth) vascular lesion typically diagnosed in early life, accounting for 5 to 10% of all congenital cardiovascular malformations but may rarely go undetected well into adulthood. The narrowing classically occurs in the proximal part of the descending thoracic aorta, just distal to the origin of the left subclavian artery.

The narrowed segment is usually short but can rarely be several centimeters long. If the narrowed segment in coarctation of the aorta is short, it can be resected and the proximal and distal cut ends of the aorta can be reapproximated directly. If the narrowed segment is longer, a direct approximation may not be possible and an interposition graft may be necessary.

As a direct result of  coarctation of the aorta (luminal narrowing of the aorta), the lesion usually manifests as childhood hypertension, lower extremity fatigue or weakness, diminished lower extremity pulses, and/or congestive heart failure. Diagnosis of coarctation of the aorta is usually based on clinical suspicion and physical findings. The latter include blood pressure difference between the upper and lower extremities, pulse delay, and systolic murmur over the thoracic spine.

Other coexisting conditions with coarctation of the aorta could include a patent ductus arteriosus, bicuspid aortic valve with systolic ejection sound(s) and/or murmurs. Confirmatory tests could include an echocardiogram or a CT scan of the chest to delineate the extent (short or long segment) of narrowing. A short segment narrowing can be corrected with a simple resection and anastamosis. A longer  narrowed segment may require an interposition graft. The procedure is usually done by a Cardiac Surgeon.

Long term Outlook in Coarctation of the Aorta.

Prognosis and survival in coarctation of the aorta depend on the disease severity and patient’s age at the time of correction. If undiagnosed and untreated, death in these patients is usually due to heart failure, coronary artery disease, aortic rupture/dissection, concomitant aortic valve disease, infective endarteritis /endocarditis, or cerebral hemorrhage. There are few reports of patients first diagnosed with uncorrected coarctation of the aorta at a very late age. Treatment consists of aggressive antihypertensive therapy, endocarditis prophylaxis, and early corrective surgical intervention.

Surgery for Coarctation of the aorta and interruption of a large PDA (an illustrative surgical video)

63 thoughts on “Surgery for Coarctation of the Aorta in an Adult – unusual occurence”

  1. Hi there, just became alert to your blog through Google, and found that it’s really informative.

    I am gonna watch out for brussels. I will be grateful
    if you continue this in future. Lots of people will be benefited from your writing.
    Cheers!

  2. Thanks for your personal marvelous posting! I seriously enjoyed reading it, you happen to be a great author. I will remember to bookmark your blog and may come back at some point. I want to encourage you to definitely continue your great posts, have a nice day! Marci Kenon Megan

  3. I became thankful to receive a call from my friend instantly he found the fundamental suggestions discussed on the site. Checking your website article is actually a superb experience. Thanks for considering readers much like me, and I want on your behalf the very best of accomplishment for a professional in this subject. Charity Dewie Abroms

  4. Nice blog here! Also your web site loads up very fast! What host are you using? Can I get your affiliate link to your host? I wish my site loaded up as quickly as yours lol Jerrylee Shamus Helban

  5. I’m not sure where you’re getting your info, but great
    topic. I needs to spend some time learning more or understanding more.
    Thanks for wonderful information I was looking for this info
    for my mission.

  6. Admiring the hard work you put into your blog and in depth information you provide.

    It’s awesome to come across a blog every once in a while that isn’t the same outdated
    rehashed information. Excellent read! I’ve bookmarked your site
    and I’m adding your RSS feeds to my Google account.

  7. Hello there, just became aware of your blog through Google, and found that it is really informative.

    I am going to watch out for mopre. I’ll be grateful if you continue this in future.

    Lots of people will be benefited from your writing.
    Cheers!

  8. Wow, wonderful weblog format! How long have you ever been running a blog for?
    you make running a blog glance easy. The full glance of
    your web site is magnificent, as well as the content!

  9. Does your blog have a contact page? I’m having a tough time locating
    it but, I’d like to shoot you an email. I’ve got some creative ideas
    for your blog you might be interested in hearing.
    Either way, great site and I look forward to seeing it develop over time.

  10. Greetings from Florida! I’m bored at work so I decided to check out your website on my iphone during lunch break.
    I enjoy the info you present here and can’t wait to take a look when I get
    home. I’m amazed at how quick your blog loaded on my phone ..
    I’m not even using WIFI, just 3G .. Anyways, great
    site!

  11. I’m truly enjoying the design and layout of your website.
    It’s a very easy on the eyes which makes it much more enjoyable for
    me to come here and visit more often. Did you hire out a designer to create your theme?
    Fantastic work!

  12. Awesome blog you have here but I was wanting to know if you knew of any discussion boards that cover the same topics discussed in this
    article? I’d really like to be a part of community where I
    can get responses from other knowledgeable people that share the same interest.
    If you have any recommendations, please let me know. Cheers!

  13. Magnificent items from you, man. I have be mindful your stuff previous to and you are just too wonderful.

    I really like what you have obtained right here, certainly like what you’re saying and the way during which you are
    saying it. You make it entertaining and you continue to take care of to keep it
    wise. I cant wait to learn much more from you. This is actually a terrific site.

  14. My husband and i got absolutely more than happy Peter could finish
    off his reports out of the ideas he gained when using the web pages.
    It’s not at all simplistic to just be giving freely helpful tips which often people have been making
    money from. And now we already know we have got the website owner to be grateful to because of
    that. All the explanations you’ve made, the straightforward blog navigation, the relationships you help instill
    – it’s got many extraordinary, and it is assisting our son and the
    family consider that this subject is amusing, and
    that is really serious. Many thanks for all the pieces!

    Visit my blog post … Primiene Reviews (networking.drbarbara.pl)

  15. Wow! This blog looks exactly like my old one!
    It’s on a entirely different topic but it has pretty much
    the same layout and design. Great choice of colors!

  16. Thanks for sharing superb informations. Your website is so cool.
    I’m impressed by the details that you have on this website.
    It reveals how nicely you perceive this subject.
    Bookmarked this website page, will come back for more articles.

    You, my friend, ROCK! I found just the info I already searched everywhere and just couldn’t
    come across. What a great web site.

  17. Its like you read my mind! You appear to know a lot
    about this, like you wrote the book in it or something.
    I think that you can do with some pics to drive the message home a bit, but other than that, this is magnificent blog.
    A fantastic read. I’ll definitely be back.

  18. Thanks for every other informative web site.
    Where else may I get that kind of info written in such a perfect
    method? I have a project that I’m just now running on, and I have been on the look out for such
    information.

  19. I’m honored to obtain a call from a friend when he found out the important
    suggestions shared on your site. Browsing your blog publication is a real fantastic experience.

    Thank you for taking into account readers much
    like me, and I want for you the best of achievements as being a professional
    in this realm.

  20. Excellent blog! Do you have any tips for aspiring writers?
    I’m hoping to start my own website soon but I’m a little lost on everything.

    Would you recommend starting with a free platform like WordPress or go
    for a paid option? There are so many choices out there that I’m totally confused
    .. Any suggestions? Thanks!

  21. litdevelopments

    Simply wanna remark that you do certainly have built a very decent internet site, I like the design it
    really stands out.

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top