Combined Full Median Sternotomy with Left Thoracotomy Approach for Recoarctation of the Aorta Associated with Aortic Regurgitation

Abstract

A 12 years-old boy was identified with coarctation of the aorta and ventricular septal defect at birth. He received extended aortic arch anastomosis for the coarctation of the aorta at the age of 1 month. He required a treatment with balloon angioplasty postoperatively for recurrent coarctation twice. On the other hand, recurrent coarctation subsequently occurred and severe aortic valve regurgitation also emerged. The recurrent coarctation developed to a minimum diameter of 5 mm and a pressure gradient of 50 mmHg across a total length of 4 cm of stenotic lesion by close examination at the age of 11 years. Moreover, severe aortic valve regurgitation was found. He had descending thoracic aortic replacement, aortic valve replacement, and ventricular septal defect closure through combined median sternotomy and left antero-lateral thoracotomy, taking considering factors such as anticipated severe adhesion around the aorta, secured establishment of selective cerebral perfusion and facilitated intracardiac repair. The postoperatively, the pressure gradient between the upper and lower limbs was diminished. Although catheter intervention and extraanatomical bypass have been variably reported for patients with recurrent coarctation, these procedures leave specific concerns in the late term. On the other hand, combined median sternotomy and left antero-lateral thoracotomy could facilitate the intracardiac repair and allow us to complete a highly curative procedure conforming anatomical repair of coarctation at the expense of seemingly excessive invasiveness.