Coarctation repair-redo challenges in the adults: what to do?

Abstract

Aortic coarctation is one of the most common congenital cardiac pathologies. Repair of native aortic coarctation is nowadays a common and safe procedure. However, late complications, including re-coarctation and aneurysm formation, are not uncommon. The incidence of these complications is dependent on the type of the initial operation. Both endovascular and conventional open repair play important roles in the treatment of late complications after previous coarctation repair. This article will review the incidence of late complications after coarctation repair and will discuss the treatment options for redo coarctation repair in adult patients.

Keywords: Coarctation; descending aortic repair; thoracic endovascular repair.

Figure 1

Contrast-enhanced computed tomography scan of a patient with native aortic coarctation before (A) and after surgical repair (B) with descending aortic replacement using the Dacron interposition graft technique.

Figure 2

Contrast-enhanced computed tomography scan of a patient who had previously undergone repair of aortic coarctation with interposition grafting. The patient subsequently developed re-coarctation that was treated with left subclavian to descending aortic bypass for recurrent coarctation following which the patient developed a pseudoaneurysm of the proximal anastomosis of the left subclavian to descending aortic bypass (arrow).

Figure 3

Extra-anatomic bypass grafting from the ascending aorta to the descending aorta for recurrent aortic coarctation in a patient who underwent previous descending aortic replacement for native aortic coarctation.