Aortic dissection distal to coarctation of the aorta with severe coronary artery disease: A case report and surgical review of a rare combination of adult congenital and acquired heart diseases.

Abstract

Coarctation of the aorta (CoA) persisting into adulthood is uncommon and may be complicated by hypertension and aortic pathology. Aortic dissection occurring distal to a coarctation segment in the presence of advanced coronary artery disease (CAD) is not uncommon, but its description in the literature - especially the management - is rarely reported. A 46-year-old male with no prior symptoms or history of comorbid illness presented with acute, tearing chest and back pain. Echocardiography revealed a CoA. Further evaluation with computed tomography angiography demonstrated a Stanford type B aortic dissection distal to the coarcted segment, and coronary angiography showed triple-vessel CAD. He underwent an open surgical repair with resection of the coarctation and Dacron graft replacement, along with triple coronary artery bypass grafting. Recovery was uneventful, and follow-up imaging confirmed durable repair and patent grafts. Vigilance for aortic complications in adults with uncorrected or residual coarctation is essential. Simultaneous repair of coarctation-associated dissection and coronary revascularization is feasible with meticulous planning.