1/92. Transdiaphragmatic graft replacement for coarctation suprarenal abdominal aorta.A 17-year-old boy was referred to us with severe hypertension, headache and intermittent lower extremity claudication. Approximately 3 months prior to admission, he began to experience headache and pain in the posterior aspect of the right thigh and calf upon walking only 20 m. Occasionally, similar symptoms developed in the left leg which were nearly always of the same intensity as on the right. Arterial blood pressure on admission to our hospital was 220/140 mmHg in the arm. After physical examination and diagnostic tests, he was operated on with the diagnosis of coarctation of the abdominal aorta. The purpose of this paper is to report on a patient having an area of coarctation just above the level of renal arteries who presented with severe hypertension and intermittent claudication and in whom there was complete relief of signs and symptoms after appropriate surgical intervention.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/92. A surgical case of atypical aortic coarctation using cardiopulmonary bypass.We report a 44-year-old woman with atypical aortic coarctation accompanied by cerebral artery disease. She was hospitalized for vertigo. An extra-anatomic bypass between the ascending aorta and abdominal aorta was performed using partial cardiopulmonary bypass under moderate hypothermia to reduce the after load of the left ventricle and maintain cerebral blood flow and cerebral perfusion pressure. The postoperative course was uneventful and there was no postoperative neurological deficiency.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/92. Pulmonary vein atresia with Shone's anomaly in an infant: a case report.We report a case of individual pulmonary vein atresia associated with multiple levels of left heart obstruction, including aortic coarctation, valvular aortic stenosis, and parachute mitral valves with stenosis. The diagnosis of pulmonary vein obstruction is likely to be missed in patients who also have other left heart obstructive diseases, since the latter usually dominates the clinical presentation. We diagnosed the existence of individual pulmonary vein atresia preoperatively via cardiac catheterization. The pulmonary artery angiograms revealed back and forth motion of the dye with no visualization of either a capillary or venous phase on the lesion side. The pulmonary capillary wedge pressure was unevenly elevated and highest on the lesion side. The results were later confirmed by operation and autopsy. Thus, selective pulmonary artery catheterization and angiography remains a good diagnostic tool to rule out the existence of pulmonary vein obstruction in cases which have multiple levels of left heart obstruction.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/92. Atypical aortic coarctation with resistant hypertension treated with axilloiliac artery bypass.A 68-year-old woman was found to have atypical coarctation of the aorta, accompanied by systolic hypertension of the upper extremities despite administration of five types of antihypertensive drugs. Since the systolic hypertension was resistant to the conventional antihypertensive therapy, axilloiliac artery bypass grafting with a subcutaneous tunnel was performed to alleviate the pressure gradient. Systolic blood pressure was successfully reduced and hypertension was controlled after surgery.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/92. Severe coarctation with similar pressure at four limbs. Clinical, catheterization, angiographic and surgical data of one case.In patient with severe coarctation of the aorta, arterial pressures were similar at the four limbs due to departure of both subclavian arteries from the descending aorta. The clinical clues to the diagnosis and the hemodynamic, angiocardiographic and surgical data are presented.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
6/92. Congenital subclavian aortic steal syndrome: hypoplastic aortic arch with severe coarctation of the aorta of unusual location.An unusual case of subclavian-aortic steal syndrome in a pediatric patient with hypoplastic aortic arch with coarctation of the aorta of unusual location is described. aortography showed hypoplasia of the arcus aorta and severe coarctation proximal to the left subclavian artery associated with an aneurysm formation on the isthmus and descending aorta. The enlargement of the arcus aorta was accomplished by prosthetic patch aortoplasty extending from the ascending to descending aorta via median sternotomy using cardiopulmonary bypass and moderate hypothermia. Postoperatively, the patient is doing well with equalized blood pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/92. Left cervical aortic arch with aortic coarctation and saccular aneurysm.Cervical aortic arch is a very rare malformation and is occasionally accompanied by other cardiovascular anomalies. A 48-year-old male patient had a left cervical aortic arch with aortic coarctation and saccular aneurysm distal to the coarcted segment. The major clinical manifestations were upper body hypertension with a 50-mmHg discrepancy between the upper and lower limbs and a loud continuous murmur in the upper chest and back. magnetic resonance angiography successfully depicted the anomalous aorta, and the aortic coarctation and aneurysm were surgically resected and the thoracic aorta was reconstructed. The discrepancy in blood pressure diminished after the operation, but antihypertensive medication was continued to satisfactorily control the hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/92. Surgical treatment for graft stenosis after repair of an interrupted aortic arch: report of two cases.We report herein two cases of patients who underwent successful reoperation for graft stenosis after repair of an interrupted aortic arch (IAA). The first patient was a 10-year-old girl who suffered from upper limb hypertension 9 years after her initial operation. cardiac catheterization revealed a pressure gradient of 55 mmHg across the repaired arch. At reoperation, a left subclavian turndown anastomosis was performed, following which the hypertension resolved and a cardiac catheterization done 5 years later demonstrated sufficient growth of the restored arch with no significant gradient. The second patient was a 17-year-old boy who suffered from general fatigue and intermittent hypertension 12 years after his initial operation. cardiac catheterization revealed a gradient of 60 mmHg across the repaired arch. He underwent an extraanatomic ascending to descending aortic bypass employing an additional 18-mm graft, and a postoperative cardiac catheterization showed no gradient between the ascending and descending aorta. Our experience has shown that IAA should be repaired without prosthetic grafts if possible. Although extraanatomic bypass is useful for reducing the operative risks at reoperation, a large graft should be used to avoid the need for a third operation. For young children expected to outgrow a second graft, performing an endogenous anastomosis, such as a left subclavian turndown anastomosis, should be considered as an alternative.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/92. hypertension in the young adult--come feel the pulse.hypertension occurring in teenagers and young adults is uncommon. Though the most common form is still essential hypertension, secondary causes are more commonly found here than in older adults. Renal, cardiovascular and endocrine diseases constitute most of these causes. Coarctation of the aorta is the most common cardiovascular cause of hypertension, and its importance lies in the fact that it is correctable, and that its persistence often leads to dangerous complications and early death. The cardinal sign of differential pulse and blood pressures between the upper and lower limbs can be detected clinically. Hence, the importance of a detailed physical examination in all young hypertensives, including palpation of all the pulses, cannot be overemphasized. We present 2 hypertensive young men who were found to have isolated coarctation of the aorta.The lesion in the first patient was located postductally just distal to the left subclavian artery.This area has been found to be the most common site of coarctation.The second patient had an unusual mid-thoracic coarctation. The clinical and radiological features as well as complications are highlighted. In young hypertensive patients, a high index of suspicion may enable the physician to make a timely diagnosis and hence avert the potentially disastrous complications that may arise in undetected cases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/92. Endovascular stenting as an emergency treatment for neonatal coarctation.We describe a neonate with critical coarctation of the aorta. Since treatment with Prostaglandin E1 had failed to reopen the arterial duct, and surgery was deemed to be associated with an unacceptably high risk in this unstable neonate, it was decided to perform balloon dilation of the coarctation as a palliative procedure to stabilize the patient. Balloon angioplasty failed to reduce the pressure gradient across the coarctation, so a stent was implanted retrogradely as an emergency procedure. Subsequently, the stented segment was resected surgically and end-to-end anastomosis created without complications at seven months of age.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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