Thorac Cardiovasc Surg 2011; 59(5): 313-316
DOI: 10.1055/s-0030-1250392
Case Reports/Cardiac

© Georg Thieme Verlag KG Stuttgart · New York

Complex Aortic Coarctation, Regurgitant Bicuspid Aortic Valve with VSD and Ventricular Non-Compaction: A Challenging Combination

P. O. Myers1 , 2 , C. Tissot3 , M. Cikirikcioglu1 , A. Kalangos1
  • 1Division of Cardiovascular Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
  • 2Children's Hospital Boston, Boston, MA, USA
  • 3Unit of Pediatric Cardiology, Geneva Children's Hospital, Geneva, Switzerland
Further Information

Publication History

received July 29, 2010

Publication Date:
22 March 2011 (online)

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.

References

Dr. Patrick O. Myers, MD

Division of Cardiovascular Surgery
Geneva University Hospitals and Medical School

24, rue Micheli-du-Crest

1211 Geneva

Switzerland

Phone: +41 2 23 72 76 24

Fax: +41 2 23 72 76 34

Email: [email protected]