Modified technique for uncommon coarctation of the aorta wit
A true presubclavian coarctation of the aorta with arch hypoplasia without major intracardiac anomaly can result in a surgical dilemma. Theoretically, one can avoid repair through median sternotomy using selective cerebral perfusion and its sequelae since no major intracardiac repair is needed.

Repair through thoracotomy is technically challenging if arch reconstruction is required and precise surgical planning is required to avoid spinal hypoperfusion and to maintain cerebral perfusion.

Moreover, inadequate repair often has resulted in hypoplastic aortic arch or residual coarctation on follow-up requiring future intervention.

Published in the journal Annals of Pediatric Cardiology, the authors have employed a modified surgical repair through thoracotomy avoiding cardiopulmonary bypass to address presubclavian coarctation of the aorta with diffuse arch hypoplasia with theoretically less chance for future stenosis.

A 30-day-old female child of 3.6 kg was referred to our institution as coarctation of the aorta. On echocardiography evaluation, the child had a borderline left ventricle, small aortic annulus (Z-score – 1.32), ascending aorta of 6.5 mm (Z-score – 1.15), borderline proximal aortic arch of 4.2 mm (Z-score – 4.04), hypoplastic distal aortic arch of 2.4 mm (Z-score – 5.58), and presubclavian coarctation of the aorta with a large patent ductus arteriosus supplying descending aorta.

Other than a small atrial septal defect, the child did not have any other intracardiac anomaly. After initial stabilization with prostaglandin, the child was taken up for surgery. A right radial and femoral arterial line was placed.

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