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Late thoracic and abdominal aortic aneurysm following discreet coarctation of the aorta repair

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A 42 year old man who had undergone resection and end to end anastomosis of a discrete coarctation at the age of 7 years developed late chronic hypertension. There was no evidence of recoarctation, but angiography showed massive aneurysmal dilatation of the descending thoracic aorta extending from the site of coarctation repair to the abdominal aorta just superior to the origin of the renal vessels, encompassing a total length of 23 cm.

Surgical repair was undertaken by placement of a 24 mm Hemashield graft, sewn in place by end to end anastomosis. One year later he remained symptom free and his hypertension was well controlled medically.

Even many years after successful surgery for coarctation, development of hypertension is common. Aortic aneurysm is well known to occur as a late complication in a small percentage of patients, and most often occurs at the site of the previous repair. Less well recognised is the potential for such patients to develop progressive aneurysmal dilatation of the aorta, usually affecting the ascending aorta (with the attendant risk of dissection). Our case illustrates the importance of long term follow up of patients with repaired coarctation, and emphasises that late complications are not necessarily restricted to the ascending aorta or the site of the original pathology.