A Case of Ascending Aorta-abdominal Aorta Bypass for Atypical Aortic Coarctation Caused by Takayasu’s Arteritis Complicated with Hypertensive Heart Failure

• Published in: Japanese Journal of Vascular Surgery Vol. 31; no. 3; pp. 117 - 121
• Main Authors: Morishima, Yuji, Arakaki, Katsuya, Kuniyoshi, Yukio
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR VASCULAR SURGERY 31.05.2022
• Subjects: ascending aorta-abdominal aorta bypass grafting; atypical aortic coarctation; hypertensive heart failure; Takayasu’s arteritis
• ISSN: 0918-6778; 1881-767X
• DOI: 10.11401/jsvs.22-00019

We herein report a case of ascending aorta-abdominal aorta bypass for atypical coarctation caused by Takayasu’s arteritis complicated with hypertensive heart failure. The patient was a 73-year-old woman admitted for heart failure. The cause of heart failure was investigated, resulting in the detection of atypical aortic coarctation, the bilateral subclavian arteries occlusion, and the left common carotid artery occlusion, so Takayasu’s arteritis was diagnosed. As the patient was initially treated with medication but sometimes suffered from heart failure due to intractable hypertension, surgical treatment was performed. She underwent a bypass grafting with a 14 mm-diameter prosthetic graft from the ascending aorta to the infrarenal abdominal aorta using cardiopulmonary bypass. After the surgery, the pressure gradient between the upper and lower body disappeared. The postoperative course was uneventful, and she was discharged 29 days after surgery. At two years since the surgery, the patient’s antihypertensive medication has been reduced on an outpatient basis, and the left ventricular load has been markedly reduced. We confirm that this procedure is acceptable in the following respects: no need to change position, acquisition of a good surgical field of view, and being able to use a large diameter prosthetic graft for bypass grafting. In addition, it provides sufficient afterload reduction and improvement of hypertension postoperatively.