Atypical aortic coarctation (author's transl)

Special problems in the surgical treatment of aortic coarctation may be caused by unusual morphological findings as a long hypoplastic segment, the combination with pre- or poststenotic aneurysms or by atypical localisation of the stenosis in the aortic arch, the decreasing or abdominal aorta. A bypass procedure is considered as the method of choice for the repair of coarctation in the aortic arch or the "critical zone" of the abdominal aorta (renal- and suprarenal segment). The bypass-principle allows many variations of branching and avoids cross-clamping of the aorta. The involvement of important branches as is the left common carotid, the superior mesenteric or the renal artery, necessitates a vascular reconstruction in the same session. Probably the first report about a very rare combined lesions is presented: the combination of an aortic arch coarctation in association with a complete situs inversus (right descending aorta), a common carotid trunc, an aneurysm of the left subclavian artery (first branch of the arch) and congenital cysts of the right upper lobe of the lung (Case No. 1). Usually concomitant aneurysms are found in the pre- or poststenotic aortic segment. Some of the infrarenal fusiform aneurysms (Case No. 4 and 5) are occasionally of poststenotic origin, secondary to a longstanding infrarenal coarctation. In these cases the procedure of choice is the total exstirpation and the interposition of a Dacrongraft. Important branches (as the subclavian or renal artery) can be some times inserted directly in the vascular protheses. Using the bypass technic or the patch graftplastic of Vosschulte the risk of late operation (beyond the age of 30 years) may be remarkably reduced.