In 1835, Schlesinger first described a case of subisthmic lower thoracic aortic coarctation. Since Olim´s unsuccessful reconstructive surgery in 1949 and Beattie´s first successful resection with homograft replacement on such a lesion in 1951 were reported, about 20 cases of atypical aortic coarctation had been treated by definitive surgery until 1964.
In Korea, only 2 cases of atypical aortic coarctation treated by bypass graft were reported until now. This is the third case-report treated by reconstructive surgery.
The patient, 11 year old girl who had 2 year history of headache, visual weakness, intermittent claudication, and general weakness, was first diagnosed of having the hypertension due to atypical coarctation by the findings of high blood pressure (170/110mmHg) at the upper extremity and weak pulsation on both femoral artery, murmur on the epigastrium, absence of aortic knob, and aortography. Aortography demonstrated the isolated segmental narrowing(length 5cm, diameter 0.4cm) at the level of aortic hiatus 2cm above celiac arterial origin, the dilated right 9th, 10th, 11th intercostal arteries with multiple dimunitive collaterals and no associated abnormalities in the other arteries.
Preoperative positive findings were strong positive mantoux test, high AST(720 units), transient. mild cardiomegaly with right lung infiltration on chest X-ray and suggestive left ventricular hyper-trophy on ECG.
On December 1970, through separate left thoracotomy and abdominal approach, bypass graft between-descending thoracic aorta and abdominal aorta below renal artery was performed. The operation was first successful with satisfactory reduction of hypertension on the upper trunk (postoperative 130/80 mmHg) and strong pulsation on the lower extremities(postop. O, postop. 140/100mmHg). However, 6 weeks after surgery, she expired of sudden hemoptysis and shock due to anastomotic leak within the thorax. Operative finding disclosed that the affected aorta was firm, with rich periaortic fibrosis and the outer diameter of stenotic site was not attenuated. Histopathology of the resected specimen was also compatible with primary arteritis..
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