A 52-year-old male patient underwent surgical correction of interrupted CoA at the age of 20 years using EABG from the LSCA to the descending aorta. He presented with transient sudden central chest pain with sweating. He is a known smoker for more than 30 years and hypertensive for almost 10 years, on losartan 100 mg once daily. The blood pressure (BP) was 140/90 mmHg, equal in four limbs with no brachiofemoral delay. There was no ischemic electrocardiography (ECG) changes or rise in cardiac biomarkers. His transthoracic echocardiography (TTE) revealed normal left ventricular (LV) function, mild bicuspid aortic valve (BAV) regurgitation, and dilated aortic root. The patient was taken to the cardiac catheterization laboratory and underwent coronary and aortic angiography, which revealed normal coronaries, dilated ascending aorta (3.8 cm), post-ductal aortic interruption, and patent EABG with complex pseudoaneurysm at the distal anastomosis site measuring 2x2.5 cm (Figure ).\nAfter the heart team discussion, endovascular treatment was deemed more feasible and safer than redo-surgery. We implanted two overlapped Valiant Thoracic Stent Graft (Medtronic Vascular, Santa Rosa, CA) proximally 22 mm X 100 mm and distally 28 mm X 100 mm. The aortic angiography revealed complete exclusion of the pseudoaneurysm and patent stent graft with no gradient (Figure ).\nThe patient did very well and was discharged home after two days. A follow-up computed tomographic (CT) angiography revealed a widely patent stent graft with no endoleaks (Figure ).
A 48-year-old male patient underwent surgical correction of interrupted CoA at the age of 22 years using EABG from the LSCA to the descending aorta. He presented with shortness of breath. The patient was found to be hypertensive with a BP of 170/90 mmHg on both arms. The BP in the lower limbs was 125/85 mmHg with obvious brachiofemoral delay. The patient was taking amlodipine 10 mg and valsartan 160 mg, both once a day. The ECG revealed LV hypertrophy. His TTE revealed normal LV systolic function, with LV hypertrophy and impaired relaxation. A CT angiography revealed stenosis at the proximal anastomosis site of the EABG (Figure ).\nThe plan was to proceed with cardiac catheterization and stenting the proximal stenosis after measuring the gradient but the patient refused any kind of intervention. The patient was sent home after adding a third antihypertensive medication, which wass bisoprolol 5 mg once a day. After six months, the patient's symptoms improved and his BP was 145/80 mmHg. His repeated TTE revealed no major changes.