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Chirurgia 2021 June;34(3):117-21

DOI: 10.23736/S0394-9508.20.05063-9


lingua: Inglese

David V procedure with concomitant ascending aorta, aortic arch and descending aorta replacement in adult patient with coarctation of aorta

Uldis STRAZDINS 1, 2, Gvido J. BERGS 2 , Rimantas BENETIS 3, 4, Martins KALEJS 2, 5, Ints PUTNINS 2, Eva STRIKE 6, 7, Peteris STRADINS 2, 8, Andrejs ERGLIS 1, 9

1 Department of Cardiology, University of Latvia, Riga, Latvia; 2 Department of Cardiac Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; 3 Department of Cardiothoracic and Vascular Surgery, Hospital of Lithuania, Lithuanian University of Health Sciences, Kaunas, Lithuania; 4 Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 5 Scientific Laboratory of Biomechanics, Riga Stradins University, Riga, Latvia; 6 Department of Cardiac Surgery Anesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia; 7 Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia; 8 Department of Surgery, Riga Stradins University, Riga, Latvia; 9 Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia

Herein we present a case of valve-sparing aortic root replacement combined with extensive thoracic aorta replacement with prosthetic interposition graft in adult patient with aortic coarctation and bicuspid aortic valve. Congenital discrete narrowing of thoracic aorta near ductus arteriosus- aortic coarctation, accounts for 4-8% of all congenital heart defects and is often undiagnosed during childhood. Aortic coarctation is often associated with bicuspid aortic valve and coexistence of both conditions is highly comorbid. Untreated, aortic coarctation is associated with high mortality and morbidity mainly due to complications caused by uncontrolled hypertension. Surgical repair is the main approach to adults with aortic coarctation and concomitant cardiac/aortic lesions. A 30-year-old patient with arterial hypertension, aortic valve insufficiency and congestive heart failure was admitted for elective surgery. Surgery was performed via median sternotomy and moderate hypothermic circulatory arrest was applied. Aortic root was replaced using a 30 mm Valsalva (Vascutek®; Inchinnan, UK) graft (David V procedure). Further aortic arch was replaced using a 30 mm tubular graft, head and neck arteries were implanted as insula and proximal descending thoracic aorta replaced using 20 mm interposition graft. Circulatory arrest times during these steps were 15 minutes for anastomosis with insula of head and neck arteries and 7 minutes for distal anastomosis. Antegrade cerebral perfusion was used during circulatory arrest. Postoperative transesophageal echocardiography (TEE) showed no residual aortic insufficiency. Postoperative course was uneventful and arterial blood pressure postoperatively was normotensive. Patient was discharged on the 12th postoperative day.

KEY WORDS: Aortic coarctation; Aorta; Case report

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