Aortic Aneurysms

Abstract

Coarctation of the aorta is a diaphragmlike ridge narrowing the lumen of the proximal descending aorta. Although surgical repair has proven to be a successful treatment of coarctation of the aorta, immediate and delayed postoperative complications are not rare. Of particular interest is the occurrence of aneurysms after Dacron patch aortoplasty--often decades after surgery. Delayed complication rates of up to 50% have been reported. We describe the clinical-radiologic presentations of 3 late complications of Dacron patch angioplasty: aortobronchopleural fistula, leaking pseudoaneurysm, and giant descending aortic aneurysm--all successfully treated with bypass grafts. Because of the high incidence of delayed complications, lifelong surveillance is necessary. The chest x-ray may be the first clue to a delayed complication. Knowledge of radiologic findings is helpful in the detection of complications-before they become symptomatic. Transesophageal echocardiography, computed tomography angiography, or magnetic resonance imaging with multiplanar reconstruction is diagnostic.

Endovascular Treatment for Pseudoaneurysms After the Surgical Repair of Aortic Coarctation

“…The surgical repair of CoA is generally associated with good long-term survival, with rates approaching 90% 25-year survival in those operated on in childhood. However, late complications are still common [ 4 ]. Redo open surgery for late surgical complications is challenging and associated with significant mortality and morbidity (including damage of the recurrent laryngeal nerve, paraplegia, and bleeding).…”

“…Redo open surgery for late surgical complications is challenging and associated with significant mortality and morbidity (including damage of the recurrent laryngeal nerve, paraplegia, and bleeding). Late pseudoaneurysms are not uncommon and should not be left untreated, as rupture has been described even in small pseudoaneurysms [ 4 ]. Knyshov et al have reported a rupture rate of 100% at 15 years post-procedure for these pseudoaneurysms [ 5 ].…”

Congenital Heart Defects in Adults : A Field Guide for Cardiologists

“…For example, the rate of aneurysm formation is much higher after Dacron patch aortopasty [174,175]. Aneurysm formation at prior balloon dilation sites remains a long-term concern [176].…”