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The long-term outcome following repair of typical aortic coarctation in adulthood may be complicated by disorders of the ascending aorta. Follow-up averaging 15 years revealed a 3.8% incidence of dilatation of the ascending aorta after such late repair. Hypertension and concomitant aortic valvular disease were common in these patients. Aortic dilatation can appear years after coarctation repair, irrespective of the operative technique and its success, and can lead to death from aortic dissection or rupture of an aortic aneurysm. Careful follow-up after coarctation repair in adulthood is advisable to detect late aortic complications.

Repair of coarctation of the aorta by synthetic patch grafting has been complicated by late aneurysm formation. These aneurysms differ macroscopically from atherosclerotic thoracic aortic dilatations. Specimens for microscopic examination were taken from 14 of 20 patients undergoing aneurysm resection. Histological analysis of the specimens showed medionecrosis in 13 patients of the specimens showed medionecrosis in 13 patients (93%), foreign body reaction in 11 patients (78%), and intimal thickening in 3 patients (21%). The three layers of the aortic wall could be identified in the aneurysms. On the basis of these results, we discuss the etiologic factors and pathogenetic mechanisms involved in the development of these aneurysms.

The long-term results of 14 adult patients who underwent a direct aortoplasty for aortic coarctation were reviewed. The mean age of the patients at operation was 31.5 years. Three of the patients died; 1 died perioperatively, and 2 died later of cardiovascular disease. The survivors were followed for 15.8 years. None of the patients had complications at the site of coarctation repair. This contrasts with our earlier findings on patch graft aortoplasties, which showed a high incidence of postoperative aneurysm at the repair site. The etiology of these aneurysms is discussed with reference to the information provided by the present study.

Twenty-two (32.8%) of 67 patients who had patch graft aortoplasty for aortic coarctation underwent reoperation because of aneurysm formation opposite or at the site of the patch. The mean age at primary repair was 25.3 years (standard deviation, 9.5 years). Reoperation took place 12.3 years (standard deviation, 3.7 years) later. In 19 patients, the aneurysm was resected and the aorta reconstructed with a tubular prosthesis. In 3 patients, the aneurysm was given external support. There were no hospital deaths. Recurrent nerve paralysis (36%) and bleeding necessitating repeat thoracotomy (32%) were the most common complications. Mean follow-up was 4.6 years. No aneurysms developed at the site of reoperation. Two patients died of causes not related to reoperation. Reconstruction with a tubular prosthesis gives good long-term results in patients with aneurysm formation after patch grafting for coarctation. External support offers technical advantages in select patients. Close follow-up of patients who have coarctation repair with a patch graft is essential.