Late hazards after repair of coarctation of the aorta

doi:10.1136/bmj.39472.693356.47

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Kunadian Vijayalakshmi, specialist registrar in cardiology,
Amanda Griffiths, ACHD specialist nurse,
Asif Hasan, consultant paediatric cardiothoracic surgeon,
John O’Sullivan, consultant paediatric cardiologist

¹Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, High Heaton, Newcastle upon Tyne NE7 7DN

Correspondence to: K Vijayalakshmi kunadianvijay{at}aol.com

Accepted 10 June 2007

Asymptomatic patients who have had surgical correction of coarctation of aorta need regular monitoring to prevent life threatening complications

Introduction

Coarctation of aorta is a relatively common type of congenital heart defect. It comprises 5-8% of all congenital cardiac defects. The first coarctation repair was carried out in 1944.1 Children operated on in the 1960s, 70s, and 80s are now adults, and it is not known how many are receiving regular specialised medical follow-up.2 Aneurysms of the aorta or in the region of the aortic isthmus are the most dangerous complications because they carry the risk of life-threatening rupture, which may be the first symptom.

We describe two patients who underwent surgical repair of coarctation of the aorta in their childhood and were lost to follow-up. Both patients presented as adults with non-specific symptoms and investigations found aneurysm of the aorta. Both patients underwent successful urgent surgery.

Case 1

A 42 year old woman presented to a district general hospital with pain in the back after a trip to the supermarket. Musculoskeletal pain was initially diagnosed and she was treated with analgesics. She did not have any important medical history except repair of coarctation of aorta (Dacron patch repair) at the age of 16 years. Coarctation of the aorta had been diagnosed incidentally at age 4 years when her general practitioner identified a heart …