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Neth Heart J. 2010 August; 18(7-8): 376–377.
PMCID: PMC2922786

Aortic aneurysm formation following coarctation repair by Dacron patch aortoplasty

Abstract

We describe the finding of an aortic aneurysm in an asymptomatic 43-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 25 years before. The role of magnetic resonance angiography as standard imaging technique in lifelong postoperative surveillance is discussed subsequently. (Neth Heart J 2010;18:376-7.)

Keywords: Aneurysm, Aortic Coarctation, Blood Vessel Prosthesis Implantation, Magnetic Resonance Angiography, Case Reports

The following case demonstrates a well-known complication late after surgical repair of aortic coarctation. A 43-year-old male patient was invited to our outpatient clinic for routine follow-up investigation in the setting of a postcoarctectomy surveillance programme. Previous surgical repair consisted of Dacron patch aortoplasty, performed at the age of 18. Since then, no complications had occurred. He was asymptomatic and no routine cardiologist’s follow-up controls had taken place during the past five years. Clinical investigation was normal. By means of contrast magnetic resonance imaging a true aneurysm was found at the distal aortic arch with a cross-sectional diameter of 7 cm (figure 1).

Figure 1
Sagital oblique contrast-enhanced 3D-surface rendered magnetic resonance angiogram of a 43-year-old patient, in whom coarctation repair was performed by Dacron patch aortoplasty at the age of 18. An aneurysm of approximately 7 cm was detected at the site ...

Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via lateral thoracotomy. Rethoracotomy had to be performed within one week in order to evacuate significant pleural effusion. Bleeding was excluded. The postoperative course thereafter was uneventful. Contrast CT imaging after three months showed a satisfactory postoperative aortic anatomy.

Aneurysms are found following all types of surgical repair of aortic coarctation, but especially after Dacron patch aortoplasty, with reported incidences up to 90% during a follow-up period of more than 20 years.1,2 The combination of clinical visit and magnetic resonance imaging in every patient has been shown the most cost-effective approach to diagnose both recoarctation and aortic aneurysms.3 Magnetic resonance imaging has been advocated especially in adults, for it adequately provides detailed composite views of the aortic arch and coarctation, including patients in whom echocardiography fails to detect recoarctation, tubular hypoplasia and aortic kinking.4-7 More important than the specific imaging technique applied is life-long postoperative surveillance after surgical repair of coarctation with regular imaging of ascending and descending aorta and aortic arch. This holds true for the asymptomatic patient also, because aneurysm formation and recoarctation, along with persistent hypertension, aortic valvular disease and left ventricular dysfunction as other late complications and associated cardiac malformations, may not present symptoms.8 Early detection may drive subsequent interventions, with lower risks than the hazards of the natural course of these conditions.

References

1. Clarkson PM, Brandt PW, Barratt-Boyes BG, Rutherford JD, Kerr AR, Neutze JM. Prosthetic repair of coarctation of the aorta with particular reference to Dacron onlay patch grafts and late aneurysm formation. Am J Cardiol. 1985;56:342-6. [PubMed]
2. Knyshov GV, Sitar LL, Glagola MD, Atamanyuk MY. Aortic aneurysms at the site of the repair of coarctation of the aorta: a review of 48 patients. Ann Thorac Surg. 1996;61:935-9. [PubMed]
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5. Simpson IA, Sahn DJ, Valdes-Cruz LM, Chung KJ, Sherman FS, Swensson RE. Color Doppler flow mapping in patients with coarctation of the aorta: new observations and improved evaluation with color flow diameter and proximal acceleration as predictors of severity. Circulation. 1988;77:736-44. [PubMed]
6. Boxer RA, LaCorte MA, Singh S, Cooper R, Fishman MC, Goldman M, et al. Nuclear magnetic resonance imaging in evaluation and follow-up of children treated for coarctation of the aorta. J Am Coll Cardiol. 1986;7:1095-8. [PubMed]
7. Vriend JW, Oosterhof T, Mulder B. Noninvasive imaging for the postoperative assessment of aortic coarctation patients. Chest. 2005;127:2295. [PubMed]
8. Vriend JW, Mulder BJ. Late complications in patients after repair of aortic coarctation: implications for management. Int J Cardiol. 2005;101:399-406. [PubMed]

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