title: Extraanatomic bypass technique for the treatment of midaortic syndrome in children.
abstract: BACKGROUND
  This report aims to introduce the extraanatomic bypass technique to treat the midaortic syndrome and to document its long-term effectiveness and durability.
  
  
  METHODS
  Fourteen patients (mean age, 6.7 ± 3.76 years; range 8 months to 11 years) received diagnoses of midaortic syndrome, characterized by severe narrowing of the abdominal aorta with involvement of the renal and visceral branches. Angiography showed variable lengths of high-grade midaortic stenosis, with 7 children having visceral artery involvement and 9 having renal artery involvement. All children were hypertensive (mean blood pressure, 165 ± 15.7 mm Hg). Three had had previous nephrectomies. Six patients had had previous percutaneous transluminal renal artery angioplasties. The midaortic obstruction was relieved by descending abdominal aorta bypass (left thoracoabdominal approach) and by an ascending abdominal aorta bypass (median sternotomy and transabdominal approach) in 12 patients. No visceral artery revascularization was done.
  
  
  RESULTS
  There was a considerable blood pressure reduction in all patients and relief of intermittent claudication in 6 affected patients. One patient had a bilateral renal artery bypass 2 weeks postoperatively because of recurrence of renal hypertension. At a mean follow-up time of 5.8 ± 1.36 years (range, 9 months to 15 years), there was no further reoperation nor mortality. Twelve patients had complete relief of hypertension, and 2 had mild hypertension. All patients have normal renal function and no signs or symptoms of visceral malperfusion. Growth and development have proceeded normally. Follow-up magnetic resonance tomography showed patent grafts without any strictures.
  
  
  CONCLUSIONS
  Extraanatomic bypass provides very effective and long-term relief of hypertension and any malperfusion in midaortic syndrome.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Daniel
authors.initials: D
authors.lastname: Absi
authors.forename: Oliver
authors.initials: O
authors.lastname: Miera
authors.forename: Natalia
authors.initials: N
authors.lastname: Solowjowa
authors.forename: Antonia
authors.initials: A
authors.lastname: Schulz
authors.forename: Mariano Francisco del Maria
authors.initials: MF
authors.lastname: Javier
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Delmo Walter
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D013577:Syndrome; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*