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Ann Thorac Surg 1998;66:600-601
© 1998 The Society of Thoracic Surgeons

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Correspondence

Coarctation with valvular lesions in adults

^a Department of Cardiothoracic Surgery, Freeman Hospital NHS Trust, High Heaton, Newcastle-upon-Tyne, NE7 7DN, England, United Kingdom

To the Editor

We read with interest the article by Mulay and associates [1], which contributes to the literature on the management of adult patients presenting with coarctation of the aorta in combination with congenital valvular lesions. Mulay and associates describe a small series of patients who underwent two-stage repair, indicating in their commentary that single-stage operations may involve correction of both lesions simultaneously through a median sternotomy with valve replacement and extraanatomic bypass from the ascending to descending aorta.

We have had recent experience of a patient with aortic stenosis and coarctation of aorta who incidentally had a carcinoma of the left kidney. We chose to approach this difficult surgical problem by undertaking a single-stage correction. A 35-year-old man presented with a history of hypertension, which was investigated, and he was found to have a coarctation of the aorta with aortic stenosis (transaortic gradient, 75 mm Hg). Magnetic resonance imaging scanning had shown a tight aortic coarctation that was not amenable to balloon dilation. While he was waiting for an operation, left loin pain developed, and subsequent computed tomographic scanning demonstrated a mass in his left kidney, possibly a carcinoma. At operation we undertook a transverse transsternal thoracotomy (clamshell incision). This incision gave excellent access to both the aortic valve and the coarctation. The patient was placed on cardiopulmonary bypass and aortic valve replacement was undertaken with a 23-mm Carpentier-Edwards valve. After valve implantation, coarctation repair was undertaken using size 18 Dacron graft. After hemostasis and closure of the chest, a left nephrectomy was performed by a separate surgical team.

The postoperative course was essentially uncomplicated, with the patient extubated on the first postoperative day. Subsequent histologic examination indicated the presence of a long-standing aortic coarctation with a dystrophic, calcified, and congenitally bicuspid valve. Histologic examination of the kidney indicated a moderately differentiated renal cell carcinoma, which had been completely excised. The patient was discharged home on the fifth postoperative day and remained well at follow-up.

We suggest that the repair of adult coarctation and correction of congenital valvular lesions through a single-stage approach is worthy of consideration and certainly avoids the potential hazards during a second-stage procedure of cessation of anticoagulation and the risk of prosthetic valve endocarditis.

References

1. Mulay A.V., Ashraf S., Watterson K.G. Two-stage repair of adult coarctation of the aorta with congenital valvular lesions. Ann Thorac Surg 1997;64:1309-1311.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen C. Clark Joseph Zacharias Asif Hasan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clark, S. C. Articles by Hasan, A. Search for Related Content PubMed PubMed Citation Articles by Clark, S. C. Articles by Hasan, A.