~ 7 ~ International Journal of Medical Anesthesiology 2022; 5(3): 07-11 E-ISSN: 2664-3774 P-ISSN: 2664-3766 www.anesthesiologypaper.com IJMA 2022; 5(3): 07-11 Received: 07-04-2022 Accepted: 09-05-2022 Dr. Indeewarie Wijesinghe Senior Registrar, Department of Anaesthesiology, Colombo National Hospital, Sri Lanka, Colombo, Sri Lanka Anuja Abayadeera Professor and Head, Department of Anaesthesia and Critical Care, Faculty of Medicine, University of Colombo, Sri Lanka Corresponding Author: Dr. Indeewarie Wijesinghe Senior Registrar, Department of Anaesthesiology, Colombo National Hospital, Sri Lanka, Colombo, Sri Lanka A rare case of abnormal narrowing and bifurcation of descending thoracic aorta and perioperative anaesthetic management during aortic bypass surgery Dr. Indeewarie Wijesinghe and Anuja Abayadeera DOI: https://doi.org/10.33545/26643766.2022.v5.i3a.353 Abstract Hypertension in paediatric population is an emergent global health issue, where the prevalence is varied among nations. Although vascular pathologies are one of the causes for secondary hypertension, mid aortic anomalies are not seen commonly. These patients usually present with uncontrolled hypertension or hypertension emergency or hypertension associated organ dysfunction. Medical management per se will be not enough to achieve a satisfactory control in blood pressure and most of them will have to undergo either surgical repair or an endovascular procedure. Perioperative management of these patients is a challenge to an anaesthetist due to multiple reasons such as haemodynamic instabilities, organ dysfunction, metabolic derangements and the need for invasive monitoring. Here we present an 8 years and 10 months old boy who was investigated for hypertension and found to have abnormal narrowing and bifurcation of the descending aorta at T10 level and underwent successful aorto-aortic bypass surgery. Keywords: Hypertension in paediatric population, haemodynamic instabilities, metabolic derangements, abnormal narrowing and bifurcation of descending Introduction Multiple vascular pathologies can lead to hypertension in paediatric population. Anomalies in descending aorta beyond the arch is not a commonly seen scenario and most of the time these patients may need to undergo an invasive procedure to achieve satisfactory control in blood pressure and to prevent end organ dysfunction [6] . Thoracic aortic surgeries comprise specific and significant challenges to an anaesthetist in the perioperative period. Here we present the case of an 8 years and 10 months old boy who underwent an aorto- aortic bypass surgery for an abnormal narrowing and bifurcation of descending aorta at T10 level and discuss about the successful perioperative anaesthetic management. Case history Previously healthy, 8 years and 10 months old (body weight 27 Kg) boy was incidentally found to have high blood pressure, while evaluating inward for an episode of shortness of breath 4 months ago. His history and rest of the examination was insignificant. He had undergone a range of haematological, biochemical and radiological investigations for the evaluation of cause of hypertension. 2D echo revealed moderate left ventricular hypertrophy with long segment narrowing of the lower thoracic to abdominal aorta. Following that, an urgent CT aortogram was performed, which showed abnormal branching of the descending aorta at T10 level (diameter at T9 level is 6mm), right trunk (10.5 mm in diameter) continuing as the distal abdominal aorta and bifurcate at L4 level to common iliac arteries. Left trunk (5 mm in diameter) gives off coeliac axis and terminates as superior mesenteric artery. Bi-lateral kidneys were normal.