A Case of Endovascular Treatment for an Atypical Aortic Coarctation with Severe Calcification in a Patient with Hypertensive Heart Failure / 日本心臓血管外科学会雑誌

@#A 52-year-old male was admitted to our hospital through the emergency room due to dyspnea and hypertensive heart failure. Computer tomography revealed atypical aortic coarctation with stenosis and calcification just above the superior mesenteric artery. Calcium channel blocker significantly reduced hypertension and improved heart failure, while his creatine elevated rapidly, and he presented acute renal failure. Endovascular self-expanding stent implantation in the aorta was performed in order to restore renal blood flow. The postoperative course was uneventful, and the patient was discharged on the third day after the procedure. The cardiac function recovered immediately, and the patient no longer required antihypertensive agents. There have been many reported cases of endovascular correction of atypical aortic coarctation overseas. Nevertheless, due to reimbursement issue in the health care system, the majority of atypical aortic coarctation cases in Japan are treated with open surgery. Endovascular treatment should be endorsed as an option for its short procedural time, minimal invasiveness and brief hospital stay.

Axillo-Bifemoral Artery Bypass for Atypical Coarctation in an Elderly Patient with Hypertensive Heart Failure / 日本心臓血管外科学会雑誌

A 81-year old woman had hypertensive heart failure. She had a history of intermittent claudication for 5 years. Her ankle brachial pressure index (ABI) was 0.53 on the right and 0.58 on the left side. Coarctation of the descending aorta with severe calcification was found by a whole body CT. After medical therapy for heart failure, axillo-bifemoral artery bypass using an 8 mm ringed expanded polytetrafluoroethylene (ePTFE) graft was performed. Postoperatively, ABI improved to 0.83 on the right and 0.87 on the left side. The patient is doing well without any signs of heart failure or intermittent claudication. Although it is a palliative operation, axillo-bifemoral artery bypass is an effective and less-invasive procedure and appropriate for elderly patients.

B-type natriuretic peptide levels in the patients with hypertensive heart failure

In 32 hypertensive heart failure patients (HHF group) including 19 male, 13 female, aged 60.3710.25 and 10 patients without HHF: 5 male, 5 female, aged 69.4  1.2, plasma BNP level in HHF group was 568.02  473.86 pg/ml and in without HHF group was 13.61  13.60 pg/ml. For HHF patients of degree I-IV, the sensitivity was 78%, and the specificity was 100% and for who of degree II-IV, sensitivity 92% and specificity 100%.