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Ann Thorac Surg 2003;76:1090-1093
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Transverse arch hypoplasia may predispose patients to aneurysm formation after patch repair of aortic coarctation

^a Department of Surgery, Division of Thoracic and Cardiovascular Surgery,, Charlottesville, Virginia, USA
^b Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA

Accepted for publication April 8, 2003.

^* Address reprint requests to Dr Kron, Department of Surgery, University of Virginia Health System, PO Box 800679, Charlottesville, VA 22908, USA.
e-mail: ikron{at}virginia.edu

BACKGROUND: Thoracic aortic aneurysm after patch repair of aortic coarctation is a potentially lethal complication. We hypothesized that transverse arch hypoplasia in association with patch repair of aortic coarctation predisposes aneurysm formation.

METHODS: A retrospective analysis was performed on all patients undergoing isolated aortic coarctation repair at the University of Virginia Health Systems between 1970 and 1995. Of 244 repairs, 38 patients underwent patch repair. These 38 patients were divided into two groups. The aneurysm group (n = 15) had aortic aneurysms develop at the repair site, which required aneurysmectomy. The nonaneurysm group (n = 23) did not have any aneurysms develop. Univariate analysis and Fisher's exact text were used to identify factors that independently predict aneurysm formation.

RESULTS: Univariate analysis demonstrated aortic arch hypoplasia associated with patch repair independently predicts future aneurysm formation (p < 0.01). Patients who had an aneurysm develop also had a similar incidence of bicuspid aortic valves, mild restenosis, and late hypertension compared with patients in the nonaneurysm group.

CONCLUSIONS: Aneurysm formation after patch repair of aortic coarctation develops into a subgroup of patients. Aortic arch hypoplasia associated with coarctation independently predicts future aneurysm formation.

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