Left Aortic Dissection following Repair of Coarctation of the Aorta

The Contribution of Abnormal Hemodynamics to Medial Degeneration

¹ Cardiovascular Division, Department of Medicine, University of Iowa, Iowa City

Although aortic dissection is a frequent complication of coarctation of the aorta, its occurrence after successful repair has not been previously reported. It has been assumed, therefore, that alleviation of the hypertension prevents progressive aortic changes leading to dissection or rupture. This paper presents two patients in whom aortic dissection or rupture occurred despite previous successful coarctation repair. Abnormal hemodynamics in coarctation may be secondary to hypertension, changes in pulsatile flow, dilatation of the ascending aorta and/or a bicuspid aortic valve. Only the first two factors are abolished with surgical repair. The contribution of abnormal hemokinetics in the propagation of aortic disruption of other etiologies is discussed.