Giant Aneurysm After Aortic Coarctation: Repair without Circulatory Arrest

Abstract

We describe the case of a 23-year-old patient presenting for redo aortic arch surgery because of recoarctation and poststenotic aneurysm formation after patch aortoplasty in infancy. Using the hemi-clamshell approach, the entire aortic arch was replaced and the supraaortic branches were reimplanted. The applied surgical technique using hypothermic extracorporeal circulation without cardiac arrest allowed an uninterrupted cerebral and spinal cord perfusion due to stepwise clamping of the aortic arch during reconstruction and resulted in an excellent neurologic outcome at six-month follow-up.

Repair of a Late Presentation Thoracic Aortic Aneurysm following Coarctation Repair

“…Importantly, to our knowledge, this is the largest post-CoA repair aneurysm described in the literature, with other authors reporting maximum diameters up to 60 mm. 6 …”

“…As noted by others, while endovascular approaches could be a valid alternative in the cases of re-CoA, large-sized postrepair aneurysms are less amenable to be treated percutaneously. 6 …”

“…Importantly, to our knowledge, this is the largest post-CoA repair aneurysm described in the literature, with other authors reporting maximum diameters up to 60 mm. 6 Despite the progressively increasing use of endovascular approaches for postrepair complication of CoA, mainly for pseudoaneurysm, the vicinity to the subclavian artery and the size of the aneurysm made percutaneous stenting not a suitable option. As noted by others, while endovascular approaches could be a valid alternative in the cases of re-CoA, large-sized postrepair aneurysms are less amenable to be treated percutaneously.…”

“…As noted by others, while endovascular approaches could be a valid alternative in the cases of re-CoA, large-sized postrepair aneurysms are less amenable to be treated percutaneously. 6 Despite recommendations in the most recent guidelines, 7 the reality of long-term follow-up of patients operated on during childhood tends to be incomplete across the units and many patients are lost to follow-up. As a result, very late presentations of post-CoA repair aneurysms have been described.…”