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2019, vol. 76, iss. 11, pp. 1197-1202
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Aortic coarctation and associated cardiac lesions: Optimal therapeutic approach: Report of 2 cases
Koarktacija aorte i pridružene lezije srca - optimalni terapijski pristup
aUniversity of Belgrade, Faculty of Medicine + Clinical Center of Serbia, Clinic for Cardiac Surgery, Belgrade bUniversity of Belgrade, Faculty of Medicine + Clinical Center of Serbia, Clinic for Cardiology, Belgrade cClinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade dClinical Center of Serbia, Clinic for Cardiac Surgery, Belgrade eUniversity of Belgrade, Faculty of Medicine + Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade fUniveristy of Niš, Faculty of Medicine + Clinical Centre Niš, Clinic of Vascular Surgery
email: velinovicsurg@gmail.com
Abstract
Introduction. Aortic coarcation is a congenital condition mostly detected and treated during childhood. Adult patients with coarctation and associated cardiac lesions represent a challenge and a subject of debates concerning adequate treatment. We report 2 patients with aortic coarctation when a surgical treatment was necessary. Case report. First patient was a 61-year-old male with previous mechanical aortic valve implantation. He underwent one stage surgical reconstruction of aortic coarctation and surgical repair of aneurysm of ascending aorta. The second patient was a 49-year-old female with aortic aneurysm, bicuspid aortic valve, severe aortic insufficiency and coarctation of aorta below branching of subclavian artery. She underwent the Bentall procedure and surgical repair of coarctation by bypass where the proximal anastomosis was made between the terminal part of Dacron graft and the lateral part of graft used for Bentall, while the distal anastomosis was made between the terminal part of Dacron graft and the lateral part of descending aorta below coarctation. The postoperative course and the follow-up of the patients of 3 and 1 year, respectively, were without complications. Conclusion. Single operation is a better choice in the patients with concomitant pathology such as the aortic aneurysm, or aortic valve disease. Each patient should be analyzed on a single basis, and a decision about a surgical technique and surgical course brought accordingly.
Sažetak
Uvod. Koarktacija aorte je kongenitalno stanje koje se najčešće otkriva i leči u detinjstvu. Odrasli bolesnici sa koarktacijom i pridruženim srčanim oboljenjima predstavljaju pravi izazov i temu za stručne polemike oko adekvatnog načina lečenja. Prikazana su dva bolesnika sa koarktacijom aorte kod kojih je hirurški tretman bio neophodan. Prikaz bolesnika. Prvi bolesnik bio je muškarac star 61 godinu sa prethodno ugrađenom mehaničkom aortnom valvulom. U jednom aktu je urađena rekonstrukcija koarktacije aorte i operativno zbrinjavanje aneurizme ascendentne aorte. Drugi bolesnik bila je 49-godišnja žena sa aneurizmom aorte, bikuspidnom aortnom valvulom, teškom aortnom insuficijencijom i koarktacijom aorte ispod odvajanja arterije supklavije. Urađena je Bental operacija i operacija bajpasa između ascendentne i torakalne aorte. Kod oba bolesnika je postoperativni tok protekao bez komplikacija. U periodu praćenja od 1 i 3 godine nije bilo komplikacija. Zaključak. Operacija u jednom aktu je bolji izbor kod bolesnika sa pridruženom patologijom kao što je aneurizma aorte i bolest aortne valvule. Svakog bolesnika treba pojedinačno razmotriti i doneti odluku o najpogodnijoj hirurškoj intervenciji.
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