Type B aortic dissection associated with coarctation of the aorta.

We describe a case of acute type B dissection associated with coarctation of the aorta, a rare pathological combination. An intimal tear was located just distal to the coarctation. Aortic dilatation started below the coarctation and extended to the level of the diaphragm. We performed descending aorta replacement from the distal aortic arch to the level of the 9th intercostal arteries through a left posterolateral thoracotomy in the fifth intercostal space. Arterial cannulations were placed on the right femoral artery and just proximal to the coarctation site in the descending aorta. To preserve the patent 10th and lower intercostal arteries, longitudinal plication of dilated pseudo-lumen was applied from the distal cut end to the level of the diaphragm. The postoperative course was uneventful.