Aortic aneurysms at the site of the repair of coarctation of the aorta: A review of 48 patients

Background. Study of the long-term results from 1 to 24 years after coarctation of the aorta repair in 891 patients showed that in 48 (5.4%, mean age, 30.9 +/- 1.1 years) aneurysms had developed at the site of repair. Aneurysms arose in 43 (89.6%) of the patients in whom repair was done with help of synthetic patch aortoplasty, in 4 (8.3%) of the patients after coarctectomy with ''end-to-end'' anastomosis, and in 1 patient (2.1%) after coarctectomy with a prosthetic graft replacement. Methods. Reoperation included aneurysm resection, which was performed in 30 patients (62.5%), followed by prosthetic graft replacement (n = 19), synthetic patch aortoplasty (n = 6), aneurysmorrhaphy (n = 3), or prosthetic bypass graft (n = 2). Results. Four (13.8%) patients died after reoperation. All 18 patients who were not reoperated on died of a ruptured aortic aneurysm 7 to 15 years after repair of coarctation of the aorta. Conclusions. With the aim to prevent aneurysm development at the site of coarctation of the aorta repair, severe limitation of indications for synthetic patch aortoplasty is necessary. It can be used only in adult patients with a not too big narrowing. Patients after primary correction of coarctation of the aorta must avoid strenuous physical activity. Chest roentgenography should be performed in these patients each year, and each year they have to be seen by a cardiac surgeon. Suspicion of aneurysm development demands hospitalization, aortography, and reoperation. Preference is given to prosthetic graft replacement using an approach through the left fourth intercostal space with distal circulatory support by means of temporary bypass shunting. Infected aneurysms can be primarily bypassed through the right anterior thoracotomy with the creation of permanent bypass with the help of a vascular graft between the ascending and descending thoracic aorta.