Unusually early recoarctation after extended end-to-end anastomosis in a neonate

A seven-day-old neonate with aortic coarctation and hypoplastic aortic arch underwent extended end-to-end repair with no residual gradient. Eleven hours after repair, femoral pulses were not palpable and recoarctation was confirmed by echocardiography. After failure of prostaglandin E2 infusion, a radically extended end-to-end anastomosis was performed eight days after initial repair. No recoarctation was evident 10 months after the second repair. The unusually early recoarctation was presumably due to residual and active duct tissue in the repair margins.