Ascending-abdominal Aorta Bypass Surgery in a Patient with Atypical Coarctation due to Aortitis Syndrome

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  • ITOH Manabu
    Department of Thoracic and Cardiovascular Surgery, University of Saga
  • NATSUAKI Masafumi
    Department of Surgery, Japan Community Healthcare Organization, Imari-Matsuura Hospital
  • OHTUBO Satoshi
    Department of Cardiovascular Surgery, Tokyoto Saiseikai Central Hospital
  • FURUKAWA Kojiro
    Department of Thoracic and Cardiovascular Surgery, University of Saga
  • MORITA Shigeki
    Department of Thoracic and Cardiovascular Surgery, University of Saga

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Other Title
  • 術後長期間画像追跡した大動脈炎症候群による異型大動脈縮窄症の1例
  • 症例 術後長期間画像追跡した大動脈炎症候群による異型大動脈縮窄症の1例
  • ショウレイ ジュツゴ チョウキカン ガゾウ ツイセキ シタ ダイドウミャクエン ショウコウグン ニ ヨル イケイ ダイドウミャクシュクサクショウ ノ 1レイ

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Abstract

We present the long-term follow-up results of a patient with atypical coarctation and aortitis syndrome.<BR>A 44-year-old woman with chronic aortitis syndrome and severe systolic hypertension (300 mmHg) was admitted to our hospital. The severe hypertension was thought to be caused by long segment stenosis of the descending thoracic aorta and atypical coarctation of the abdominal aorta. We performed extra-anatomical ascending-abdominal aorta bypass surgery via a median sternotomy and a midline laparotomy. Proximal anastomosis of a 16 mm artificial graft was performed with partial clamping of the ascending aorta. During clamping, the blood pressure of the upper limb was controlled by antihypertensive drugs. Following the proximal anastomosis, the graft was passed through a hole made in the diaphragm and across the omental sac, and the distal end of the graft was anastomosed to the infra-renal abdominal aorta. A right subclavian left subclavian artery bypass was performed using a 6 mm Gore-Tex graft. Three years after surgery, the patient presented with active Takayasu's aortitis, and was prescribed oral prednisolone therapy. The severe hypertension was gradually controlled, and near normal blood pressure was achieved 10 years after surgery. Computed tomography 21 years after surgery showed good patency of the artificial graft and did not reveal false aneurysm at the anastomosis site. The long-term prognosis of this patient was satisfactory with ongoing medical treatment with 6 mg of prednisolone. In this case with atypical coarctation and aortitis syndrome, it was necessary to control postoperative blood pressure and a change in the inflammatory activity of aortitis during long-term follow-up.

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