Recurrent of Aortic Coarctation in Extra-anatomical Bypass Surgery

Shigehiro Morishima	Takashi Ono	Megumu Kanno
Hirofumi Midorikawa	Takashi Takano and Kyouhei Ueno

（Department of Pediatric Cardiovascular Surgery, and Cardiovascular Surgery＊, Southern Tohoku General Hospital and Southern Tohoku Research Institute for Neuroscience, Fukushima, Japan）

Recoarctation, systemic hypertension, aortic aneurysm and intracranial aneurysm are generally observed within a certain period after the surgical procedure for aortic coarctation, which is known as a systemic diseases caused by not only morphological abnormalities but also arterial functional abnormalities of artery. Here, we report a case who showed complications of recoarctation, hypertension and subarachnoid hemorrhage after surgery for aortic coarctation. A 17-year-old boy originally presented to our hospital with upper extremity systemic hypertension. Recoarctation after surgery for aortic coarctation was diagnosed in his childhood, following which hypertension was followed while he received continuous treatment with anti-hypertensive drugs. He was hospitalized with sudden headache and loss of consciousness. Since subarachnoid hemorrhage was diagnosed by computed tomography, clipping of intracranial aneurysms was performed. After the clipping procedure, he underwent percutaneous intravascular stenting angioplasty. However, the pressure gradient remained and sufficient dilatation was not obtained because of the hypoplastic anatomical distal aortic arch（from the left internal carotid artery to the site of recoarctation）due to the development of collateral circulation with rib notch. At age 21, extra-anatomical bypass（from the ascending aorta to the descending aorta）was performed because of persistent upper extremity systemic hypertension. However, systemic hypertension continued to require antihypertensive medication.

　

Jpn. J. Cardiovasc. Surg. 43:108-113（2014）

Keywords：recurrent coarctation;extra-anatomical bypass surgery;intracranial aneurysm;aortic aneurysm;hypertension