ANEURYSMS OF THORACIC AORTA IN COARCTATION SYNDROME

A.A. Spiridonov, E.G. Tutov, V.S. Arakelyan
Department of Major Vessels Surgery, A.N. Bakulev Scientific Center of Cardiovascular Surgery, Russian Academy of Medical Sciences,
Moscow, Russia

Surgical outcomes of 126 paracoarctation aneurysmal resections and 47 reconstructions of kinking with aneurysms of distal aortic arch or descending thoracic aorta are analyzed. The rate of thoracic aortic "congenital aneurysms" in coarctation syndrome was 47.3% among surgical procedures for thoracic aortic aneurysms. Main diagnostic modalities used for patients with congenital thoracic aortic aneurysms were: chest radiography in 3 projections with esophageal contrasting, chest digital radiography, echocardiography, transesophageal echocardiography, nuclear magnetic resonance, 3-dimensional spiral computed tomographic angiography, angiography. Surgical strategy for "congenital aneurysms" in coarctation syndrome was characterized by: spinal cord and visceral organs protection from ischemic damage, when arterial pressure gradient between upper and lower extremities was less then 40 mm Hg; bilateral ligation of 5 or more intercostal arteries; expanded mobilization of aortic arch to enable aortic clamping proximally to the left common carotid artery; obligatory correction of anatomic anomalies leading to hemo- or hydrodynamic disturbances in aortic isthmus; one-stage total resection of aneurysmal tissues; use of modem equipment for physiologic monitoring and autohemotransfusion. During the last 2 decades no fatal outcomes of paracoarctation corrections were registered. Mortality after surgical interventions for kinking was 4.2% (2 patients died). Five-year survival rate was 95.7%.

P. 96-106

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