Synthetic patch angioplasty for repair of coarctation of the aorta: experience with aneurysm formation.

Patch graft angioplasty is an accepted technique for the repair of some forms of coarctation and for recoarctation. Since 1970, 63 patients at our institution underwent 65 operations for repair of coarctation (ages 3 days to 32 years); in 27 it was the initial operation and 38 needed surgery for recoarctation. Average follow-up was 3.5 years (range 3 months to 14 years). There was one death, 20 patients with persistent hypertension, and eight patients with a persistent arm/leg pressure gradient (14 to 30 mm Hg at rest). Five patients required reoperation, two for recoarctation and three for aneurysm formation. The aneurysms were found on routine chest x-rays 3, 3.7, and 13.5 years after surgery. All aneurysms were repaired with left heart bypass in which a Dacron tube graft was used without complications. Synthetic patch angioplasty to repair coarctation was effective; however, aneurysm formation was a late complication in 5% of our patients. All patients undergoing patch repair should be followed on a yearly basis to allow early detection of aneurysms.