Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation

doi:10.1007/s11684-013-0261-7

Front Med

2013, Vol. 7

Issue (2) : 270-273 https://doi.org/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 Author(s): Song Haibo,Email:pdasonghaibo@163.com

Issue Date: 05 June 2013

Cite this article:

Fei Liu,Ming-chon Hsiung,Haibo Song, et al. Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation[J]. Front Med, 2013, 7(2): 270-273.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0261-7
https://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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