Aortic aneurysm after patch angioplasty for aortic isthmic coarctation in childhood

Abstract

Repair of aortic coarctation, pioneered by Craaford and Nylin 1 and Gross and Hufnagel 2 in 1944, is an accepted procedure with relatively low morbidity and mortality rates. Repair was initially accomplished by excision of the aortic coarctation with end-to-end anastomosis of healthy aortic tissue. Newer techniques, such as patch angioplasty 3–5 and subclavian flap angioplasty, 6 were introduced to avoid the complications of stricture at anastomotic site and allow for further growth of the aorta. Reports of aneurysm formation in the region of the patch angioplasty 7–9 have raised concern as to long-term safety of this procedure. Development of a large true aneurysm of the aorta in 2 asymptomatic patients (Fig. 1) who underwent primary repair of coarctation by the technique of patch angioplasty (the subject of a previous report 10) prompted recall of all patients who underwent repair of coarctation of the aorta at the University of Virginia Hospital since 1971. This study assesses the incidence of aortic aneurysm in the pericoarctation region after surgical repair of coarctation of the aorta in childhood, and attempts to determine if the presence of aneurysmal dilatation was related to the type of operative procedure, age at operation or presence of residual gradient.