Surgery
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The hypothesis is presented that paraplegia after coarctation of the aorta is principally due to hypotension of sufficient severity and duration. In a group of 103 patients who underwent surgery during a 10-year period, the distal aortic pressure was maintained above 60 mm Hg while the aorta was cross-clamped or the period of cross-clamping was limited to less than 20 minutes. No neurologic problems occurred. ⋯ In five of six patients with large thoracicoabdominal aneurysms in whom sensory potentials were absent for longer than 30 minutes, paraplegia resulted. Use of somatosensory potentials provides a significant method for evaluating methods to protect from paraplegia. This method should be far more productive than are simple clinical experiences because the fortunate rare occurrence of paraplegia, one in 200, greatly limits available data.
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A 21-year-old man presented with fever and septicemia resistant to antibiotic therapy. An unusual post-coarctation mycotic aortic aneurysm that had eroded into the left main stem bronchus was identified and replaced with a Dacron graft. A critical factor in achieving the satisfactory result was preparation of the femoral vessels for autotransfusion and possible cardiopulmonary bypass.