Open repair for thoracoabdominal aortic aneurysms precipitated by chronic aortic dissection

Chronic dissection of the thoracoabdominal aorta may require surgical repair for aneurysm, malperfusion, or rupture. Endovascular repair is made difficult by a noncompliant dissection septum, visceral vessels arising from different lumens, and the common use of diseased aortic landing zones. Thus, open repair remains the gold standard in terms of favorable outcomes and durability. During thoracoabdominal aortic repair, we use a multimodal strategy to prevent spinal cord and visceral or renal artery ischemia; key modalities include cerebrospinal fluid drainage, left heart bypass with and without visceral protection, cold renal protection, and aggressive reimplantation of intercostal or lumbar arteries. Patients with chronic dissection require lifelong surveillance, as there is a significant risk for subsequent intervention on unrepaired aortic segments.

SURGICAL TREATMENT OF AORTIC COARCTATION IN 29-YEAR OLD PATIENT

We present a case of 29-year-old-woman diagnosed with severe coarctation of the aorta 15mm distal to the left subclavian artery. The patient was admitted in our institution, computed tomohraphy(CT) scan was performed - confirming the diagnosis. After heart team meeting discussion, decision was taken for surgical correction as the best option for the case. Cardiac surgery procedure was performed including: resection of coarctation segment and aortic prosthesis interposition using left heart bypass for optimum spinal cord and visceral organs protection. The patient was discharged on postoperative day 7 on drug therpapy with antiplatelet and dual antihypertensive therapy with β-blocker and calcium channel blocker: Aspirine, Metoprolol and Lercanidipine. At late follow-up examination one year after the surgical correction the patient was normotensive at rest, as well as after treadmill stress test using the standart Bruce protocol. Despite the established good cardiac prophylaxis on newborns, sometimes this disease can remain undiagnosed until adulthood when the complications are starting to present.

Staged Repair of Concomitant Aortic Regurgitation and Descending Thoracic Aortic Aneurysm

Descending thoracic aortic (DTA) aneurysms causing left main bronchus compression can be surgically repaired under left heart bypass (LHB). Safe LHB requires a competent aortic valve. Some patients present with concomitant DTA aneurysms and severe aortic regurgitation (AR), precluding LHB as an adjunct for aortic surgery. The authors present such a case and outline the management. AR can safely be addressed first in an immediate staged surgical approach, providing adequate left ventricular function.

Surgical Treatment of Dysphagia Lusoria Caused by Right-Aortic Arch with Kommerell Diverticulum: Left Heart Bypass without Subclavian Revascularization

The authors present the case of a 26-year-old patient suffering from dysphagia because of compression by a Kommerell diverticulum in right aortic arch anomaly. Open surgical arch and descending aorta replacement with left heart bypass without left subclavian artery reimplantation was performed.