Anaesthesia management of pregnant patient with uncorrected middle aortic syndrome (MAS) for caesarean section

Middle aortic syndrome is a rare congenital disease which involves segmental or diffuse narrowing of the abdominal and/or distal descending thoracic aorta. It may remain largely undetected in childhood and can present itself as gestational hypertension during pregnancy. Upper extremity hypertension is difficult to control during pregnancy. Excessive blood pressure lowering may result in hypotension distal to the obstruction and uterine hypoperfusion.It offers considerable challenge to Anaesthesiologist regarding choice of anaesthesia – Regional verses General Anaesthesia. Both having its own advantages and disadvantages in such patient.We describe a 29 years, primigravida with Middle aortic syndrome, diagnosed during first trimester. Patient was admitted with severe hypertension in upper extremity at 39 weeks. Caesarean delivery was carried out under General Anaesthesia. During perioperative period, Intravenous Nitroglycerine and Labetalol were used to maintain hemodynamic stability. Patient was shifted to ICU on ventilator. She had uneventful course in ICU and recovery was good.Pregnant Patient with uncorrected Middle aortic syndrome for Caesarean Section require suitable anaesthesia technique along with good blood pressure management leading to early recovery and reduction in complications.

Surgical 5-year Outcomes of Extra-Anatomical Bypass for Middle Aortic Syndrome: A Case Series

Background Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome. Case presentations Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu’s arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle–brachial pressure index was .61. The three patients with Takayasu’s arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle–brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up. Conclusion Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.

Treatment of middle aortic syndrome with thoraco-abdominal aortic bypass grafting assisted by endoscope in adult

Middle aortic syndrome (MAS) is a rare disease characterized by distal thoracic aorta or abdominal aorta coarctation, and thoraco-abdominal aortic bypass grafting is an effective treatment for this condition. However, significant trauma is associated with the conventional surgical approach. We report a 26-year-old woman with MAS who presented with hypertension and needed thoraco-abdominal bypass grafting. In this operation, we adopted the endoscopic technique to improve the conventional surgical approach (reduce the incision). This case report shows that it is safe and feasible to use an endoscopic technique to reduce the trauma during this kind of operation, and provides a reference for similar treatments.