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Ann Thorac Surg 1982;34:125-131
© 1982 The Society of Thoracic Surgeons

Articles

Management of Ascending Aortic Aneurysm Complicating Coarctation of the Aorta

Ramanathan Sampath, M.D., William N. O'Connor, M.D., Jacqueline A. Noonan, M.D., Edward P. Todd, M.D., Ph.D.*

From the Department of Surgery, Division of Cardiothoracic Surgery, and the Departments of Pathology and Pediatrics, University of Kentucky Medical Center, Lexington, KY

* Address reprint requests to Dr. Todd, Division of Cardiothoracic Surgery, University of Kentucky Medical Center, 800 Rose St., Lexington, KY 40536

Four patients with coarctation of the aorta complicated by an aneurysm of the ascending aorta are described. One patient, treated only medically, died suddenly. For the 3 patients who underwent operation, management was similar. Pharmacological control of blood pressure and repair of the aortic coarctation to achieve anatomical reduction in afterload (stage I) were followed after an interval of one to five weeks by surgical repair of the ascending aortic aneurysm (stage II).

Initial repair of the coarctation relieves proximal hypertension, thereby decreasing the chance of progressive dissection or rupture of the aneurysm. It also permits safe arterial cannulation for perfusion during correction of the aneurysm in the second stage. In patients not requiring valve replacement in stage II, continued long-term follow-up for progression of aortic valvular disease appears to be necessary.




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