Giant Aortic Aneurysm After Patch Repair of Coarctation
A 31-year-old asymptomatic man was seen by a cardiologist for a routine examination. Eighteen years previously, at the age of 13 years, the patient had undergone a Dacron aortoplasty for aortic coarctation. Findings from the clinical examination and transthoracic echocardiography were normal; the exercise test revealed ST-segment depression not associated with angina. A chest x-ray was performed, which depicted a huge ballooning of the descending aorta, suggestive of an aortic aneurysm (Figure 1). The subsequent 16-row, multislice computed tomography scan confirmed a 100×110-mm large aneurysm at the site of the earlier patch angioplasty, as well as a hypoplastic aortic arch (Figure 2).
The patient was referred to our institution for surgical intervention. The operation was accomplished through a posterolateral thoracotomy with cardiopulmonary bypass and profound hypothermic circulatory arrest. Intraoperatively, the aneurysm was observed to have originated from the proximal descending aorta at the site of the Dacron patch (Figure 3). The aneurysm was resected, and a 24-mm Hemashield graft was interposed, thus also augmenting the arch. Postoperative images showed a perfect result with no residual gradient (Figure 4). The patient recovered uneventfully and was discharged without symptoms.
In the follow-up of patients after coarctation repair, particularly after patch aortoplasty, one should anticipate aneurysm formation, even decades after the initial successful surgery and in the absence of clinical symptoms. Therefore, a chest x-ray should be a routine component of the follow-up examination.