Alternative single stage approach for dealing with CoA and associated cardiac disease.
jagannath byalal, Frontier life line hospital Chennai India
28 July 2006
I read with great interest the article detailing the use of sternotomy, TCA and extranatomic conduit for bypassing the coarcted segment. It indeed is an excellent palliation in the sense that it still uses a conduit, needs TCA which certainly is not totally benign and the conduit lie, position and length must be carefully adjusted so that compression by the cardiac mass does not occur.
We had a patient recently who was 50 yrs old, had severe calcific aortic stenosis and a very tight coarctation.
I elected to do both at a single sitting using a transverse sternotomy with a left thoracotomy extended onto the right side a little bit. In this particular instance I opened the right pleura but I believe that the same could be done without opening the pleura on the right side.
The access to the coarct segment was very good, I did a resection end to end anastomosis and followed with an aortic valve replacement in the usual fashion.
The patient did very well and is ready for discharge.
The only disadvantage is that the IMA on both sides may have to be sacrificed, however if concomitant grafting is needed then it can easily be harvested and used.
Moreover the access to the arch vessels is excellent and can be repaired .
So although the sternotomy approach with a extraanatomic graft may be a viable alternative I prefer to use the thoracotomy,transverse sternotomy approach.
Alternative single stage approach for dealing with CoA and associated cardiac disease.
28 July 2006
I read with great interest the article detailing the use of sternotomy, TCA and extranatomic conduit for bypassing the coarcted segment. It indeed is an excellent palliation in the sense that it still uses a conduit, needs TCA which certainly is not totally benign and the conduit lie, position and length must be carefully adjusted so that compression by the cardiac mass does not occur.
We had a patient recently who was 50 yrs old, had severe calcific aortic stenosis and a very tight coarctation.
I elected to do both at a single sitting using a transverse sternotomy with a left thoracotomy extended onto the right side a little bit. In this particular instance I opened the right pleura but I believe that the same could be done without opening the pleura on the right side.
The access to the coarct segment was very good, I did a resection end to end anastomosis and followed with an aortic valve replacement in the usual fashion.
The patient did very well and is ready for discharge.
The only disadvantage is that the IMA on both sides may have to be sacrificed, however if concomitant grafting is needed then it can easily be harvested and used.
Moreover the access to the arch vessels is excellent and can be repaired .
So although the sternotomy approach with a extraanatomic graft may be a viable alternative I prefer to use the thoracotomy,transverse sternotomy approach.
Competing interests
no competing intersets