[Descending thoracic aorto-aortic bypass grafting for coarctation of the aorta in an adult combined with a cerebral arterial aneurysm--a case report].

Coarctation of the aorta (CoA) in adults is often accompanied by hypertension, but CoA combined with a cerebral arterial aneurysm is rare. We performed successfully descending thoracic aorto-aortic bypass grafting for CoA in an adult who had a cerebral bleeding and a cerebral arterial aneurysm. The patient was a 46-year-old female who had the history of hypertension. She suddenly suffered from left hemiparesis due to cerebral bleeding, then a left middle cerebral arterial aneurysm and CoA were detected at the same time. Aortography showed that the internal diameter of the portion of the coarctation was 2.8 mm and the poststenotic dilatation was prominent. The peak systolic pressure gradient across the coarctation was 60 mmHg. We took the precedence of the surgical repair for CoA over that for the cerebral arterial aneurysm, because her cerebral arterial aneurysm was judged to have less risk to rupture from the viewpoint of its size and shape by neurosurgeons. We performed proximal descending thoracic aorto-distal descending thoracic aortic bypass grafting with a woven double velour graft of 16 mm in internal diameter and 9.5 cm in length. Intraoperative cerebrovascular hypertension can be avoided by this procedure. Furthermore the peak systolic pressure gradient has disappeared immediately after grafting. In general, the coarctectomy with direct end-to-end anastomosis is prevalent for CoA in adults. On the other hand, the descending thoracic aorto-aortic bypass grafting for CoA in adults has rarely been reported.(ABSTRACT TRUNCATED AT 250 WORDS)