The Constrictor Band- Coarct!

We have performed a rare surgery. I thought sensitising the people about this  condition would be useful.

A 37 Yr old lady from Nashik went on a tour to Vaishnodevi.  On her way back she complained of recurrent headaches and heaviness. This had happened before , occasionally,  but was passed on as not significant. This time though , she sought medical attention and found that her BP was 220/110. This was way above the normal range.  The doctor at Nashik promptly did a few tests. On 2D Echocardiography she was detected to have a Coarctation of Aorta. This was confirmed on CT Aortogram. 

Coarctation of Aorta is a congenital inborn condition in which the child is born with a severe narrowing of the great vessel which supplies blood all over the body I.e Aorta. This is located at the junction of the arch and descending Thoracic Aorta. This condition causes elevated blood pressure of the upper half of the body and low blood pressures of the lower half of the body. This condition is also associated with other heart defects like ventricular septal defect, patent ductus arteriosus, bicuspid aortic valve, arch hypoplasia, sub aortic stenosis, cerebral aneurysms. In our case she had a double chambered right ventricle with a bicuspid  aortic valve.

In childhood, the treatment of this condition is surgery, in which the narrow segment is removed and the two ends are joined back. In adulthood this is not possible and either a bypass or stenting can be done. Bypass is the gold standard. Without treatment most people die before the age of 40. 

In her case stenting was attempted , but failed. She was then referred to us for surgery.

In surgical bypass , through an incision over the chest , and using a DACRON tube graft a selective bypass is performed. Before bypass , her upper body pressures were 160/55 and lower body pressures were 82/52. Post surgery the pressures between the upper  part and lower part of the body had normalised.

Since she may need a cardiac surgery later in life , the sternum was kept intact.

This condition if not detected in time can lead to stroke and heart failure due to high blood pressure. Hence screening for it is essential when hypertension is detected in a young patient. the workup includes screening for renal artery stenosis, renal parenchymal disease, thyroid and other hormonal causes [ cortisol, mineralocorticoid, cathecholamine excess] and drugs and obstructive sleep apnoea.

In our case we discharged the patient 5 days after surgery. She is currently doing well. The surgery was performed by Dr Swarup Swaraj Pal , a Cardiovascular and Thoracic and Transplant surgeon at Dr L H Hiranandani  hospital in Mumbai. He is a KEM hospital and Apollo Hospitals Chennai alumnus and practises in Mumbai. 

Image representation of the condition and surgery are attached.. 

Pic 1 - DACRON graft

Pic 2 - coarctation 

Pic 3- surgical drawing of the bypass done

Pic 4- actual surgical pic

Pic 5-causes of HT in young

 Video LINK-

https://youtu.be/zfHljd2X0rs?si=V6VXg6ET9QQ3yw9m

https://www.youtube.com/watch?v=zfHljd2X0rs