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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (2) : 270-273     DOI: 10.1007/s11684-013-0261-7
CASE REPORT |
Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation
Fei Liu1, Ming-chon Hsiung2, Haibo Song1(), Ke Dian1, Hong Tang1, Jin Liu1
1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041,China; 2. Department of Cardiology, Cheng Hsin General Hospital, Taibei, Taiwan, China
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Abstract  

In the presence of a large patent ductus arteriosus (PDA), aortic co-arctation (CoA) cannot be diagnosed clinically because PDA masks the clinical features. This condition impedes the identification of CoA by transthoracic echcocardiography. However, the closure of PDA can result in a severe clinical condition that causes a patient with undiagnosed CoA to suffer from shock and multi-organ failure. In this article, a case of PDA was presented, in which transesophageal echocardiography provided full information that could be used as reference to identify and define CoA during PDA ligation surgery.

Keywords patent ductus arteriosus      aortic co-arctation      transesophageal echocardiography     
Corresponding Authors: Song Haibo,Email:pdasonghaibo@163.com   
Issue Date: 05 June 2013
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0261-7     OR     http://academic.hep.com.cn/fmd/EN/Y2013/V7/I2/270
Fig.1  Patent ductus arterious by TEE. DAO, descending aorta; PDA, patent ductus arterious; and PA, pulmonary artery.
Fig.2  (A) Mid-esophageal descending aortic short axis view showing blood flow from the intercostal artery (blue and red arrows) crossing the descending aorta after PDA ligation. (B) Mid-esophageal descending aortic short axis view in the descending aorta after surgery. This part also supplies blood (blue and red arrows) to the intercostal artery. (C) No blood flow signal is observed in the left renal artery after PDA ligation. (D) Normal blood flow (blue and red arrows) is observed in the left renal artery after surgery. AO= Descending thoracic aorta.
Fig.3  Excised segment of CoA. Arrow 1 points to the proximal end of CoA close to the aortic arch. Arrow 2 points to the residual end of PDA. Arrow 3 points to the distal end of CoA close to the descending aorta. PDA, patent ductus arteriosus.
Fig.4  Diagram of the proposed mechanisms of PDA masking the symptoms of CoA. (A) PDA functions as a conduit bypassing the site of potential obstruction for patients with left-to-right shunt. (B) PDA functions as a channel through which blood flows from the pulmonary artery to supply the descending aorta. (C) After closure of the PDA, the presence of juxtaductal co-arctation becomes manifested by a pressure difference between ascending and descending aortas.
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