Ascending-to-Descending Aortic Bypass through a Median Sternotomy for Residual Coarctation of the Aorta

(Department of Cardiovascular Surgery, Tenri Yorozu Hospital, Tenri, Japan, and Department of Cardiovascular Surgery*, Kyoto, Japan)

Yuji Sekine Tadashi Ikeda* Tatsuya Furutake
Kenta Ann Daisuke Nakatsuka Michihito Nonaka
Atsushi Iwakura Kazuo Yamanaka
A 11-year-old boy was admitted to our hospital with a diagnosis of the progressive residual coarctation of the aorta, severe left ventricular hypertrophy and dilatation of the ascending aorta. He had previously undergone 3 operations for coarctation of the aorta. We performed ascending-to-descending aortic bypass through a median sternotomy for residual coarctation of the aorta. Partial cardiopulmonary bypass(CPB)was established via the right femoral artery and right atrium. A cephalad retraction of the heart with a heart positioner and a longitudinal pericardial incision over the descending aorta allowed excellent exposure of the aorta through the posterior pericardium. The graft was anastomosed to the ascending aorta and descending aorta. The graft was brought around the right lateral aspect of the right atrium and through to the anterior aspect of right pulmonary veins and inferior vena cava. The bypass graft size was 14mm in diameter. The CPB time was 134 min, and operation time was 232 min. The postoperative course was uneventful, and he did not suffer from paraplegia. His blood pressure postoperatively normalized without medication. He was discharged 20 days after surgery. The ascending-descending aortic bypass through a posterior pericardium approach is a safe and effective option for relieving residual coarctation and improving hypertension, for patients who have complex coarctation requiring surgical correction. However, because of his young age(II)it is necessary to follow him up carefully.
  Jpn. J. Cardiovasc. Surg. 39:258-261(2010)

Keywords:residual aortic coarctation, median sternotomy, antianatomical bypass, ascending-to-descending aortic bypass, pericardial posterior approach