Extra-anatomical Bypass in a Case of Recoarctation and Previous Cardiac Surgery

A complex clinical case of aortic recoarctation is presented. The case is a 61-year-old comorbid patient with two previous aortic and cardiac operations. At the age of 10, the patient underwent surgery for post-ductal coarctation of the aorta (adult type) at the typical site, where the stenotic area was completely resected, and an end-to-end anastomosis was performed through a left-sided thoracotomy. Ten years ago, the patient also had mitral valve replacement with a metallic prosthesis due to severe mitral insufficiency, performed via median sternotomy. The patient was admitted to the cardiac surgery unit due to symptoms suggestive of aortic re-stenosis due to status post repair of coarctation of the aorta (resection with end-to-end anastomosis). An extra-anatomic bypass was performed between the ascending and abdominal aorta, with the graft passing through a new diaphragm opening in front of the hilus of the right lung.