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\begin{document}

\title{An unusual case of coarctation of the aorta and a concurrent large-size
aortic arch aneurysm in an adult}



\author[1]{Wei Huang}%
\author[1]{Jiayi Song}%
\author[1]{Yongjun Qian}%
\affil[1]{Sichuan University West China Hospital}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\selectlanguage{english}
\begin{abstract}
We presented a multimodal imaging approach to identifying aortic arch
aneurysm with a concurrent coarctation of the aorta in a 52-year-old
woman. We successfully adopted a new operative method and described the
management of whole process. The detailed imaging and intraoperative
data have not been reported in the literature before. This case
highlighted the feasibility and successful surgical intervention in a
patient with coarctation of the aorta and a concurrent enormous aortic
arch aneurysm. An extra-anatomical bypass is an innovative surgical
technique that is proved effective and beneficial.%
\end{abstract}%



\sloppy


\textbf{Title Page}

\textbf{An unusual case of coarctation of the aorta and a concurrent
large-size aortic arch aneurysm in an adult}

Wei Huang\textsuperscript{1}, MD; Jiayi Song\textsuperscript{2}; Yongjun
Qian\textsuperscript{3\#}, MD, PhD.

\textsuperscript{1} Department of Rehabilitation Medicine, West China
Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan,
610041, People's Republic of China.

\textsuperscript{2} West China School of Medicine, West China Hospital,
Sichuan University, Chengdu, 610041, People's Republic of China.

\textsuperscript{3} Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan,
610041, People's Republic of China.

\textsuperscript{\#} Address for correspondence: Yongjun Qian

Address: No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, P.R. China

Phone: +86 028 85422897

Fax: +86 028 85421833

E-mail:\emph{qianyongjun@scu.edu.cn}



\textbf{An unusual case of coarctation of the aorta and a concurrent
large-size aortic arch aneurysm in an adult}

\par\null

Wei Huang\textsuperscript{1}, MD; Jiayi Song\textsuperscript{2}; Yongjun
Qian\textsuperscript{3\#}, MD, PhD.

\textsuperscript{1} Department of Rehabilitation Medicine, West China
Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan,
610041, People's Republic of China.

\textsuperscript{2} West China School of Medicine, West China Hospital,
Sichuan University, Chengdu, 610041, People's Republic of China.

\textsuperscript{3} Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan,
610041, People's Republic of China.

\textsuperscript{\#} Address for correspondence: Yongjun Qian

Address: No. 37 GuoXue Xiang, Chengdu, Sichuan, 610041, P.R. China

Phone: +86 028 85422897

Fax: +86 028 85421833

E-mail:\emph{qianyongjun@scu.edu.cn}

\textbf{Abstract}

We presented a multimodal imaging approach to identifying aortic arch
aneurysm with a concurrent coarctation of the aorta in a 52-year-old
woman. We successfully adopted a new operative method and described the
management of whole process. The detailed imaging and intraoperative
data have not been reported in the literature before. This case
highlighted the feasibility and successful surgical intervention in a
patient with coarctation of the aorta and a concurrent enormous aortic
arch aneurysm. An extra-anatomical bypass is an innovative surgical
technique that is proved effective and beneficial.

\textbf{Keywords:} Congenital heart disease

A 52-year-old woman was admitted to our department with a high blood
pressure of 180/70 mmHg measured at the right upper limb, and at both
lower limbs, the blood pressure was lower, at 90/50 mmHg. The
transthoracic echocardiography revealed a bicuspid aortic valve,
moderate aortic valve regurgitation, coarctation of the aorta (COA), and
a huge aortic arch aneurysm in close proximity to the left common
carotid artery \emph{(Figure 1, panels A and B)} . Computed tomography
was performed which confirmed the diagnosis and demonstrated that the
left subclavian artery was originated from and deformed by the
aneurysm\selectlanguage{ngerman}\emph{(5.1×4.8cm) (Figure 1, panels C and D)} . Given the
findings, surgery was carried out to correct abnormalities. The Bentall
procedure was performed to reconstruct the aortic valve and ascending
aorta. A 22-mm Dacron graft was used to anastomose to the thoracic
descending aorta in an end-to-side fashion while the other end of the
dacron graft was anastomosed to the graft in Bentall procedure
\emph{(Figure 1, panels E and F)} . Then, part of the aneurysm was
excised and the left subclavian artery was ligated.

Diffuse aortic dissection or medial degenerative disease involving the
entire aortic arch may result in the development of an exceedingly large
aneurysm.\textsuperscript{{[}1{]}} On the other hand, COA is a
heterogeneous disorder affecting individuals of all age groups. Patients
with COA present with varying clinical symptoms, either in isolation or
in association with other cardiac
defects.\textsuperscript{{[}2{]}}Aortic arch aneurysm with a concomitant
COA is a rare cardiac malformation and remains a devastating disease
associated with underlying serious complications such as sepsis,
coagulopathy, and aneurysm rupture. In patients with COA, the outcome is
poor without surgical correction. The mean age of death was 34 years,
with the mortality rate reaching 75\% at 43 years of
age.\textsuperscript{{[}3{]}} Since the first surgical intervention for
correcting the COA described by Crafoord\textsuperscript{{[}4{]}} in
1944, advancements have been made in surgical techniques to improve the
quality of treatment and the outcome of patients with this disorder.
Despite improvements in the mortality and morbidity rates, operations
for the COA continue to carry significant risks of adverse events or
patient morbidity. Concomitant aortic arch aneurysm combined with COA is
extremely rare. Therefore, individualized patient assessment and careful
plans for the most suitable treatment approach are required before on
embarking a high-risk surgery. Our case highlighted the feasibility and
successful surgical intervention in a patient with COA and a concurrent
enormous aortic arch aneurysm. An extra-anatomical bypass was performed
which proved beneficial in this case.

\textbf{CONFLICT OF INTERESTS}

The authors declare that there are no conflict of interests.

\textbf{ETHICS STATEMENT}

This manuscript and all of its content meet the ethical guidelines,
including adherence to the legal requirements of the study country. The
need for patient consent was waived.

\textbf{FUNDING}

This study was funded by 1·3·5 project for disciplines of
excellence-Clinical Research Incubation Project, West China Hospital,
Sichuan University (ZYJC21064).

\textbf{References}

1. Patel, H.J., Deeb, G.M. Ascending and arch aorta pathology, natural
history, and treatment. Circulation. 2008; 118 (2):188--195.

2. Rachel D Torok, Michael J Campbell, Gregory A Fleming, Kevin D Hill.
Coarctation of the aorta: Management from infancy to adulthood
{[}J{]}.World Journal of Cardiology, 2015; 7(11):765-775.

3. Campbell M. Natural history of coarctation of the aorta. Br Heart J
1970; 32: 633-640 {[}PMID: 5470045 DOI: 10.1136/hrt.32.5.633{]}

4. Kvitting JP, Olin CL. Clarence Crafoord: a giant in cardiothoracic
surgery, the first to repair aortic coarctation. Ann Thorac Surg
2009;87:342-346 {[}PMID:19101336 DOI: 10.1016/j.athoracsur.2008.08.
072{]}

\textbf{Figures}

\textbf{Figure 1.} Panels A\&B, the transthoracic echocardiography
revealed a bicuspid aortic valve, moderate aortic valve regurgitation
(arrow), coarctation of the aorta, and a huge aortic arch aneurysm in
close proximity to the left common carotid artery. Panels C\&D, computed
tomography and three-dimensional reconstruction demonstrated that the
left subclavian artery was originated from and deformed by the aneurysm.
Panels E\&F, Dacron graft (asterisk) was used to anastomose to the
thoracic descending aorta in an end-to-side fashion, the other end of
the Dacron graft was anastomosed to the graft in Bentall procedure. (LV,
left ventricle; LA, left atrium; CoA, coarctation of aorta; Aneu,
aneurysm; AA, ascending aorta; DA, descending aorta; BPG, bypass graft.)\selectlanguage{english}
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