Thoracic aortic aneurysm: a late complication of coarctation repair.

CASE REPORT

A 67-year-old female patient had a patch repair of an aortic co-arctation in 1972 and a mechanical aortic valve replacement in 2002 for a bicuspid valve. It was noted at the time of the repair that the aorta was ectatic and regular follow-up was suggested.

She was followed up with yearly echocardiograms. It was noted that the diameter of descending aorta had increased to from 4.5 cm in 2013 to 5.4 cm in 2014 and a computed tomography (CT) aortogram revealed an 8-cm saccular aneurysm of the aortic arch around the site of the coarctation repair, involving the left subclavian artery (Fig. 1). This was treated with a complex hybrid thoracic endovascular aneurysm repair [1].

Figure 1:

Saggital and coronal views of the aneurysm.

DISCUSSION

Late complications after coarctation repair include re-coarctation and aneurysm formation. Aneurysm formation and rupture are responsible for ∼7% of deaths [2]. Patch repairs are most prone to this although aneurysm formation does not start to occur until >20 years after repair [3].

The American College of Cardiology guidelines suggest that there should be imaging of the repair site by magnetic resonance imaging (MRI) or CT for at least 5 years [4], and there is expert opinion that follow-up should take place in specialist centres with a multidisciplinary approach under the direction of cardiologists with an interest in grown-up congenital heart disease [5]. Echo is not the best modality for visualizing the descending aorta and it is clear that echo in this case underestimates the size of the aneurysm.

This case would argue for more frequent follow-up and we would suggest that all thoracic aneurysms undergo at least yearly surveillance as this case would suggest that once an aneurysm develops, it can progress rapidly over the course of a year. The use of MRI if possible would allow for a reduction in radiation dose for patients undergoing regular imaging.

CONFLICT OF INTEREST STATEMENT

None declared.

FUNDING

No funding support was received for this article.

ETHICAL APPROVAL

Not required.

CONSENT

Consent was gained from the patient for the use of images—see the attached form.

GUARANTOR

W.W. is a guarantor of this study.