Single-Stage Repair of Complex Congenital Aortic Arch Pathology With Dissection and Aneurysm in an Adult.

BACKGROUND

Complex congenital aortic arch anomalies in adults are rare and may present abruptly when complicated by dissection or aneurysm, posing significant surgical challenges.

CASE SUMMARY: A 42-year-old man presented with sudden-onset chest and back pain. Computed tomography angiography demonstrated aortic coarctation, right aortic arch with an aberrant left subclavian artery arising from Kommerell diverticulum, and associated arch and descending thoracic aortic aneurysm with dissection. Because of the absence of suitable landing zones for endovascular repair, a single-stage anatomical repair via median sternotomy was performed, including hemiarch reconstruction, proximal descending thoracic aortic replacement, and bilateral subclavian artery reconstruction. Postoperative recovery was complicated by bleeding requiring re-exploration and pulmonary infection, both successfully managed.

DISCUSSION: Simultaneous management of multiple congenital arch anomalies with dissection is rarely reported and highlights the feasibility of single-stage repair.

TAKE-HOME MESSAGE: Single-stage repair can provide definitive treatment in carefully selected patients with complex anatomy.