Treatment of Severe Aortic Stenosis Accompanied with Vascular Ring in a 70-Year-Old Patient - Case Report

    Authors

    Keywords

    aortic stenosis, vascular ring, treatment

    DOI

    https://doi.org/10.15836/ccar2022.204

    Full Text

    **Aim:** To present a therapeutic modality of a 70-year-old patient with double-vessel coronary disease, along with associated severe aortic stenosis and vascular ring. **Case report:** Patient admitted for elective coronary angiography because of preoperative preparation due to surgical treatment of accidentally detected severe aortic stenosis (peak aortic valve velocity of 4.4 m/sec, peak gradient of 80 mmHg, mean gradient of 47 mmHg, aortic valve area of 0.8 cm2 (continuity equation using velocity time integral (VTI)), with preserved left ventricular ejection fraction. Double-vessel coronary disease was verified by coronary angiography and percutaneous coronary intervention (PCI) of left anterior descending with drug eluting stent (DES) implantation and right coronary artery with DES implantation was done. Echocardiography verified the orderly dimensions of the visible part of the aorta, while computed tomography demonstrated the presence of anatomical variation in the right-sided aortic arch, with slight compression of the esophagus by the left subclavian (**Figure 1**). Surgical revascularization treatment was indicated, with aortic valve replacement through V-type mini sternotomy. During the operation and in the postoperative course, there was no need for blood and blood products. Throughout the procedure, the patient was hemodynamically stable, without catecholamine support. On the second postoperative day, the patient was transferred to post-intensive care, while on the fifth postoperative day, the patient was discharged home. FIGURE 1. Right-sided aortic arch with aberrant left subclavian artery. **Conclusion:** Mini sternotomy represents an optimal therapeutic modality for severe valvular heart disease (1, 2), even when it is accompanied with an anomalous vascular structure.

    Literature

    1. Sahni D, Franklin WH. Vascular Ring Double Aortic Arch. 2022 Sep 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
    2. Kaczmarczyk M, Pacholewicz J, Kaczmarczyk A, Filipiak K, Hrapkowicz T, Zembala M. Ministernotomy for aortic valve replacement improves early recovery and facilitates proper wound healing - forced propensity score matching design with reference full sternotomy. Kardiochir Torakochirurgia Pol. 2022 March;19(1):1–10. https://doi.org/10.5114/kitp.2022.114548
    Cardiologia Croatica
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    Treatment of Severe Aortic Stenosis Accompanied with Vascular Ring in a 70-Year-Old Patient - Case Report

    Extended Abstract
    Issue9-10
    Published
    Pages204
    PDF via DOIhttps://doi.org/10.15836/ccar2022.204
    aortic stenosis
    vascular ring
    treatment

    Authors

    Nermir Granov*ORCIDClinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
    Hened Kelle-KaravdićORCIDClinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
    Zina LazovićORCIDClinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
    Alden BegićORCIDClinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
    Edin BegićORCIDClinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
    Fuad ZukićORCIDClinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    *Correspondence email: nermir@hotmail.com

    Full Text

    Aim: To present a therapeutic modality of a 70-year-old patient with double-vessel coronary disease, along with associated severe aortic stenosis and vascular ring.

    Case report: Patient admitted for elective coronary angiography because of preoperative preparation due to surgical treatment of accidentally detected severe aortic stenosis (peak aortic valve velocity of 4.4 m/sec, peak gradient of 80 mmHg, mean gradient of 47 mmHg, aortic valve area of 0.8 cm2 (continuity equation using velocity time integral (VTI)), with preserved left ventricular ejection fraction. Double-vessel coronary disease was verified by coronary angiography and percutaneous coronary intervention (PCI) of left anterior descending with drug eluting stent (DES) implantation and right coronary artery with DES implantation was done. Echocardiography verified the orderly dimensions of the visible part of the aorta, while computed tomography demonstrated the presence of anatomical variation in the right-sided aortic arch, with slight compression of the esophagus by the left subclavian (Figure 1). Surgical revascularization treatment was indicated, with aortic valve replacement through V-type mini sternotomy. During the operation and in the postoperative course, there was no need for blood and blood products. Throughout the procedure, the patient was hemodynamically stable, without catecholamine support. On the second postoperative day, the patient was transferred to post-intensive care, while on the fifth postoperative day, the patient was discharged home.

    FIGURE 1. Right-sided aortic arch with aberrant left subclavian artery.

    Conclusion: Mini sternotomy represents an optimal therapeutic modality for severe valvular heart disease (1, 2), even when it is accompanied with an anomalous vascular structure.

    Literature

    1. 1.
      Sahni D, Franklin WH. Vascular Ring Double Aortic Arch. 2022 Sep 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
    2. 2.
      Kaczmarczyk M, Pacholewicz J, Kaczmarczyk A, Filipiak K, Hrapkowicz T, Zembala M. Ministernotomy for aortic valve replacement improves early recovery and facilitates proper wound healing - forced propensity score matching design with reference full sternotomy. Kardiochir Torakochirurgia Pol. 2022 March;19(1):1–10.DOI