Late complication rates after aortic coarctation repair in patients with or without a bicuspid aortic valve

ObjectivePatients with previously repaired aortic coarctation (CoA) are at risk of developing late surgical complications. Many patients with CoA also have a bicuspid aortic valve (BAV). We sought to determine in patients with repaired CoA whether the presence of BAV is associated with more cardiovascular reinterventions during follow-up.MethodsAdults with previously repaired simple CoA were recruited from our Adult Congenital Heart Disease database (Sydney, Australia). The incidence of complications relating to the ‘CoA-site’ (descending aortic aneurysm or dissection, or recoarctation) and the ‘AV/AscAo’ (aortic valve or ascending aortic pathology) that required intervention was compared between those with BAV (‘CoA-BAV’) and without BAV (‘CoA-only’).ResultsOf 146 patients with repaired CoA, 101 (69%) had BAV. Age at CoA repair was similar (median 6.0 (IQR 0.5–14.0) years vs 5.0 (IQR 0.5–11.0) years, p=0.44), as was the distribution of repair types, with end-to-end repair the most common in both groups (45.9% vs 45.6%). At a median of 28 years following initial repair, a significantly higher proportion of patients with CoA-BAV required cardiovascular reintervention (45.5% vs 20.0%, p=0.003). Whereas ‘CoA-site’ complications were more common than ‘AV/AscAo’ complications in patients with CoA only (13.3% and 0%, respectively), patients with CoA-BAV had a high prevalence of both ‘CoA-site’ as well as ‘AV/AscAo’ complications (19.8% and 21.8%, respectively). Overall survival was similar (p=0.42).ConclusionIn adults with repaired CoA, patients with CoA-BAV are more than twice as likely to require cardiovascular reintervention by early-to-mid-adult life compared with those with CoA alone. Despite this, no difference in survival outcomes was observed.

Aneurysm of the descending thoracic aorta presenting with paraplegia which significantly resolved following surgical repair

Spinal cord infarction secondary to dissecting thoracic aortic aneurysm is a relatively rare phenomenon; it is uncommon for descending aortic aneurysm to present with paraplegia. We report the case of 60 year old man presenting with sudden onset paraplegia secondary to spinal cord infarction caused by dissecting thoracic aortic aneurysm with intraluminal thrombus. Spinal MRI confirmed findings and he underwent emergency surgery. Post-operatively he displayed neurological improvement, and was mobilising with a frame by 2-month outpatient clinic review.

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

A silent trio: giant descending aortic aneurysm combined with coarctation and persistent left brachiocephalic truncus

We report the case of an undiagnosed descending aortic aneurysm, combined with coarctation and persistent left brachiocephalic truncus in a 59-years old male. This case underscores the increased necessity for aortic imaging while facing a poorly controlled hypertension, erroneously considered as of essential origin.

Mechanical ventilation variability due to tracheal compression in a patient with a mycotic descending aortic aneurysm: an inverse correlation with blood pressure

Mycotic aortic aneurysms carry significant morbidity and mortality. In the current report, we present a case of a patient with a mycotic descending aortic aneurysm with contained rupture causing variable compression of the trachea, influenced by a variability in blood pressure. In these patients, blood pressure management is paramount as relative hypertensive periods do not only increase the risk of rupture but can also warrant high ventilation pressures or can potentially result in airway occlusion.

Open descending aortic replacement in a patient with a fractured Djumbodis™ dissection system

The Djumbodis™ dissection system was introduced as an alternative to aortic arch replacement in acute type A aortic dissection involving the arch. In our own experience, some patients with Djumbodis implantation developed distal aortic arch and descending aortic aneurysm during subsequent follow-up and required additional interventions. However, as there is a high incidence of fracture associated with the Djumbodis system, further endovascular interventions are not feasible. We report a case of successful open descending aortic replacement in a patient with a fractured Djumbodis stent system.