Scientific article
Case report
English

Complex aortic coarctation, regurgitant bicuspid aortic valve with VSD and ventricular non-compaction: a challenging combination

Published inThe thoracic and cardiovascular surgeon, vol. 59, no. 5, p. 313-316
Publication date2011
Abstract

Left ventricular non-compaction is a myocardial disorder characterized by excessive trabeculations and deep recesses that communicate with the ventricular cavity, which is thought to result from a failure of the trabecular regression that occurs during normal embryonic development. It carries a high mortality from heart failure or sudden cardiac death. A 15-year-old female patient was referred to our institution for moderate symptoms of heart failure. Echocardiography and MRI showed a bicuspid aortic valve with severe regurgitation, subaortic VSD, dilated left ventricle and left ventricular non-compaction with a moderately decreased ejection fraction, as well as isthmic coarctation and transverse arch hypoplasia. We elected to perform transaortic VSD closure and aortic valve replacement using a mechanical prosthetic valve on an arrested heart, and to address aortic coarctation and transverse arch hypoplasia using an extra-anatomic ascending-to-descending aorta bypass. Aortic cross-clamping was limited to 41 minutes. The postoperative recovery was rapid and the girl was discharged in NYHA class I with an estimated LVEF of 39%. Although management must be individualized, extra-anatomic bypass is a good single-stage approach for patients with complex coarctation and concomitant cardiovascular or myocardial disorders, reducing ischemic time and offering a better chance of successful weaning from cardiopulmonary bypass.

Keywords
  • Abnormalities, Multiple
  • Adolescent
  • Aortic Coarctation/complications/diagnosis/surgery
  • Aortic Valve/abnormalities/surgery
  • Aortic Valve Insufficiency/complications/diagnosis/surgery
  • Blood Vessel Prosthesis Implantation
  • Cardiac Surgical Procedures
  • Cardiopulmonary Bypass
  • Echocardiography, Doppler
  • Female
  • Heart Failure/etiology
  • Heart Septal Defects, Ventricular/complications/diagnosis/surgery
  • Heart Valve Prosthesis Implantation
  • Humans
  • Isolated Noncompaction of the Ventricular Myocardium/complications/diagnosis/surgery
  • Magnetic Resonance Imaging
  • Treatment Outcome
Citation (ISO format)
MYERS, Patrick Olivier et al. Complex aortic coarctation, regurgitant bicuspid aortic valve with VSD and ventricular non-compaction: a challenging combination. In: The thoracic and cardiovascular surgeon, 2011, vol. 59, n° 5, p. 313–316. doi: 10.1055/s-0030-1250392
Main files (1)
Article (Published version)
accessLevelRestricted
Identifiers
Journal ISSN0171-6425
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First validation16/11/2012 11:57:00
Update14/03/2023 17:48:56
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