Extra-Anatomic Ascending Aorta to Abdominal Aorta Bypass in Takayasu Arteritis Patients with Mid-Aortic Syndrome

BACKGROUND: We evaluated the operative outcomes of an extra-anatomic bypass from the ascending aorta to the abdominal aorta in patients with type II or III Takayasu arteritis (TA) with mid-aortic syndrome. METHODS: From 1988 to 2014, 8 patients with type II (n=2) or III (n=6) TA underwent an ascending aorta to abdominal aorta bypass. The mean patient age was 43.5±12.2 years and the mean peak pressure gradient between the upper and lower extremities was 54.8±39.0 mm Hg. The median follow-up duration was 54.4 months (range, 17.8 to 177.4 months). RESULTS: There were no cases of operative mortality. The mean peak pressure gradient significantly decreased to −2.4±32.3 mm Hg (p=0.017 compared to the preoperative value). Late death occurred in 2 patients. The symptoms of upper extremity hypertension and claudication improved in all patients. The bypass grafts were patent at 47.1±58.9 months in 7 patients who underwent follow-up imaging studies. CONCLUSION: An extra-anatomic ascending aorta to abdominal aorta bypass could be an effective treatment option for severe aortic steno-occlusive disease in patients with type II or III TA, with favorable early and long-term outcomes.

Mild-Aortic Syndrome : A Cause of Recurrent Abdominal Pain

Mid-aortic syndrome (MAS) is a rare clinical entity that is characterized by coarctation involving the distal thoracic and/or abdominal aorta and its major branches accounting for 0.5–2% of all cases of coarctation of the aorta (1). Renovascular hypertension can be a significant sequelae - it is the main symptomatic presentation of this disease among children and adolescents. We describe a 9-year-old girl who presents with recurrent abdominal pain and symptomatic hypertension. Due to significant left ventricular systolic dysfunction and uncontrolled hypertension, percutaneous balloon angioplasty was performed to treat the coarctation. To our knowledge, this is the first reported case of MAS in Malaysia. This case report highlights the clinical presentation, the role of computed tomography angiogram (CTA) in the diagnosis and current options in the management of MAS.

Successful Surgical Revascularization in a Case of Mid-Aortic Syndrome / 日本心臓血管外科学会雑誌

A case of successful surgical revascularization for mid-aortic syndrome is reported, with discussion of the operative method. A 10-year-old boy with headache and vomiting was admitted to our hospital for excessive hypertension. A diagnosis of mid-aortic syndrome with severe stenosis of abdominal aorta and stenosis or occlusion of bilateral renal arteries was made. His hypertension did not respond to conservative treatment. Therefore we performed aorto-aorta bypass using a prosthetic graft and revascularization of the bilateral renal arteries. The preoperative symptoms disappeared, his blood pressure became controllable, and he was discharged on the 21st day after surgery. At present, he attends school and has a normal blood pressure without hypotensive medication.