[HSF] patinets with coactation

[陈鑫]

 Dear Members:

I have a paptient and hope to have your advice:

15-year boy with hypertension for about 3 years. the Bp of the right arm is 160/80mmHg, left arm is 120/70mmHg, the low extremity is 70/30mmHg. CT and Angio shows: the coactation begining at between left carotid and subclauvian artery. And there is aneurysmal dilation ( irregular dilation, little bigger than the middle part of decending aorta)  from the coactation to the prosimal part of the decending aorta. and after that the aorta looks normal in diameter. He is indication for surgery for sure. 

option:
1. do a bypass from ascenging to decending? how big size of the graft? 16mm? 18mm? 
2. replace the distal arch and proximal decending aorta under DHCA? aproch? left anterior thoracotomy and go transvers the sternm? mid-stermotomy?

which is much safe, lower surgical risk and better long term result.

many thanks in advance

steve