Successful surgical treatment of the supradiaphragmatic middle aortic syndrome by an extra-anatomical bypass in a child

We report a 5-year-old girl (13kg) was referred to our facility for cardiologic examination due to uncontrolled hypertension and significant heart failure. Chest radiography elevated cardiothoracic ratio of over 60% with rib notching and the absence of an aortic knob. Transthoracic echocardiography showed a dilated left ventricle with a reduced ejection fraction and significant stenosis of the descending aorta with a pressure gradient of 64 mm Hg. Computed tomography angiography confirmed the type of supradiaphragmatic middle aortic syndrome, with severe stenosis segment 75 mm of the descending aorta was visible around 20 mm above the diaphragm. The narrowest point was estimated to be 1.85 mm. In addition, the ascending aorta, aortic arch, and supra-cervical branches were all normal, as were the abdominal aorta and its major branches. Our patient underwent surgery, a 9.0 mm Dacron bypass was performed between the ascending and the terminal descending thoracic aorta. Extra-anatomical ascending-to-descending aortic bypass is a relatively safe and successful therapy option for supradiaphragmatic middle aortic syndrome.