211287 Surgery for adult coarctation with the ascending-abdominal aorta bypass procedure

/;Liu Wei(刘巍，Dept Cardiac Surg，Beijing Anzhen Hosp，Cap Med Univ，Beijing 100029)…∥Chin J Thorac Cardiovasc Surg.-2011，27(1).-11 ～13

ObjectiveTo explore the surgical effects and follow-up results in treating adult aortic coarctation patients using ascending aorta-abdominal aorta vascular prosthesis bypass and summarize the clinical experiences.MethodsFrom May 2008 to July 2009，ascending aorta-abdominal aorta vascular prosthesis bypass surgery was performed in nine patients with adult aortic coarctation，among which，four were male，and five were female，with average age of 42.6 years old.All patients had upper extremity hypertension，the systolic blood pressure difference between their upper extremities and lower extremities was 55-100 mm Hg，mean(70.2 ± 15.6)mm Hg.Among which，seven cases showed descending aorta aneurysmal dilatation at coarctation segment distal end，with the wall thinning;two cases showed long segment stenosis;three cases showed aortic wall near coarctation segment was calcified.All cases belonged to complex aortic coarctation.All patients underwent radial artery and dorsalis pedis artery puncture manometry，the surgical effects were evaluated according to mean pressure difference changes between radial artery and dorsalis pedis artery before and after operations.ResultsAll patients were cured and discharged，without brain and spinal cord and other nervous system complications.All patients’upper extremity hypertension has been significantly improved，before operation，the mean pressure difference between radial artery and dorsalis pedis artery was 36-63 mm Hg，mean ［(48.2 ± 5.6)mmHg］;24 hours after operation，the mean pressure difference between radial artery and dorsalis pedis artery was 0-13 mm Hg，mean ［(6.2 ±1.6)mmHg］，significantly reduced(P ＜0.05)compared with that before operation，no death case occurred by 1-13 mouths of postoperative follow-up，all patients’upper extremity hypertension disappeared，no need for oral antihypertensive drugs，the mean pressure differences between upper extremities and lower extremities after operations were all less than 20 mm Hg，thoracoabodominal aorta main vessels multi-slice CT examination three months after operation showed that bypass vascular prosthesis was unobetructed，two cases showed that autologous artery at aortic coarctation distal end were partly occluded.ConclusionAscending aortaabdominal aorta vascular prosthesis bypass would be an effective means for treatment of adult aortic coarctation patients.9 refs，4 figs.