Large aneurysm of the ascending aorta 15 years after coarctectomy
W.Budts1, J.Bogaert2, W.Daenen3
1Cardiology, 2Radiology, 3Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium
This 41-year-old male patient had undergone a coarctectomy (Dacron graft interposition) at the age of 26. Fifteen years later, as no follow-up data were available, he was invited for a routine check-up at the adult congenital heart disease outpatient clinic.
He was asymptomatic and was working as a road constructor. This involved carrying loads of more than 100 kg each day. He had been doing this for many years. On physical examination there were no signs of recoarcation. However,transthoracic echocardiography showed an aneurysm of the ascending aorta. On chest X-ray, the mediastinum was enlarged (panel A, arrow). On magnetic resonance imaging, the maximal diameter of the aneurysm was 85 mm (panel B, arrow). The Dacron graft at the site of the coarcatectomy appeared normal (panel B, double arrow). A mildly stenotic and functionally bicuspid aortic valve, giving rise to turbulent ascending aortic flow, associated with anatomopathologically confirmed cystic media necrosis of the aorta wall, was the trigger for the development of this large aneurysm. The patient subsequently underwent a successful Bentall repair. This case again demonstrates that late follow-up of patients with coarctectomy remains an extremely important issue in adult congenital heart disease.
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