A Case of Coarctation of Aorta undergoing Bilateral Hernioplasty under Graded Epidural

A 39-year-old male with a history of coarctation of the aorta, treated with patch angioplasty in 2002, presented with bilateral inguinal swelling and pain, worsening with exertion. Physical examination revealed reducible, doughy swellings in both inguinal regions, each with a positive cough impulse. Blood pressure readings showed a marked difference between the upper and lower limbs, with elevated pressure in the arms. Cardiovascular examination was unremarkable aside from normal heart sounds. His past surgical history included two thoracotomies for haemothorax and wound infection. Laboratory findings were normal. Imaging confirmed bilateral inguinal hernias containing bowel and omentum, and echocardiography showed severe restenosis of the aorta, with associated left ventricular hypertrophy and diastolic dysfunction. The patient was classified as ASA IV, indicating high surgical risk due to his complex cardiac condition. For anaesthesia, a graded epidural block was selected, and close intraoperative monitoring included arterial line placement and continuous blood pressure monitoring. The epidural was carefully administered in increments to achieve a T6 level sensory blockade. Hemodynamic stability was maintained throughout the procedure with close monitoring of vital signs. Sedation was provided with midazolam and fentanyl, ensuring patient comfort. Postoperative plans included ICU monitoring and readiness for inotropic support if required. The patient’s stable intraoperative course demonstrated effective anaesthetic management, aligning with the high-risk nature of his cardiovascular profile. This case underscores the importance of individualized anaesthetic planning and vigilant perioperative monitoring in patients with complex cardiovascular comorbidities to ensure a safe and stable surgical outcome.