Isthmic Aortic False Aneurysm Post-Patch Coarctation Aortoplasty: A Hybrid Solution.

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Congenital Heart Disease

Background:

• The patient presented with dyspnea, a history of aortic coarctation repair via patch aortoplasty 40 years prior.
• She had dextrocardia (heart positioned on the right side) and a solitary kidney, adding complexity to surgical planning.

Observation:

• Computed tomography revealed a large, 10-cm saccular false aneurysm at the aortic repair site.
• Echocardiography confirmed severe aortic regurgitation due to a bicuspid aortic valve and a 34 mm ascending aorta diameter.

Findings:

• A two-step surgical strategy was employed for management.
• This involved biologic aortic valve and ascending aorta replacement with total debranching of epiaortic vessels.
• Thoracic endovascular aneurysm repair was performed for complete false aneurysm exclusion.

Implications:

• This case highlights a successful complex, multi-stage intervention for aortic pathology in a patient with significant congenital anomalies.
• The described approach offers a potential solution for managing large false aneurysms post-aortoplasty in high-risk patients.
• It underscores the importance of advanced imaging and tailored surgical techniques for rare cardiovascular conditions.