Middle Aortic Syndrome Repair in a 14-Month-Old Child: A 24-Year Case Study.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Vascular Endovascular

Background:

• Mid-aortic syndrome (MAS) is a rare congenital condition causing severe hypertension and potential organ damage.
• Juxta-diaphragmatic aortic coarctation is a critical manifestation of MAS requiring timely intervention.

Purpose of the Study:

• To present the 24-year follow-up of a patient with MAS treated in childhood.
• To highlight the long-term efficacy of combined surgical and endovascular strategies in MAS management.

Main Methods:

• Initial aorto-aortic thoracoabdominal bypass for juxta-diaphragmatic aortic coarctation.
• Subsequent endovascular recanalization and stenting for graft-related complications.
• Long-term clinical and imaging surveillance.

Main Results:

• The patient remained asymptomatic, normotensive, and active at 24-year follow-up.
• Initial bypass graft became occluded, but distal perfusion was maintained via endovascular interventions.
• Normal ankle-brachial indices and pulse volume recordings confirmed adequate distal perfusion.

Conclusions:

• Early diagnosis and intervention are crucial for managing MAS.
• A hybrid approach utilizing both surgical and endovascular techniques can achieve durable long-term results in MAS.
• Continuous surveillance is essential for monitoring treatment effectiveness and addressing late complications.