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 30-year-old asymptomatic female with a history of surgically repaired aortic coarctation presented for routine follow-up. Chest computed tomography angiography (CTA) demonstrated a left-sided IVC with hemiazygos continuation to the left-sided SVC in the absence of right-sided SVC (Figure ), a very rare systemic venous anomaly. The left-sided superior vena cava was draining to the enlarged coronary sinus, and the hepatic veins were directly connected to the right atrium (Figure ).\nThe case has been followed up for the coarctation without any treatment regarding to venous anomaly.