Late sudden death after surgical correction of coarctation of the aorta. Importance of aneurysm of the ascending aorta.

Follow-up studies averaging 12 years postcorrective surgery of 343 patients with coarctation of the aorta disclosed 38 late deaths, 15 of which were sudden, unexpected and probably cardiovascular. All but two patients were normotensive postoperatively, and in 4 of these the cause of death was proven dissecting aneurysm of ascending aorta. In another patient this aneurysm was repaired surgically and in 3 other patients chest X-ray had shown a dilated ascending aorta before death. At follow-up the ascending aorta was dilated angiographically in 4 survivors, who had moderate systolic hypertension and aortic valve disease. The high incidence of aneurysm of ascending aorta in patients with coarctation is probably due to hypertension during the growth period, possibly in combination with congenital weakness of the aortic wall, and to concomitant aortic valve lesion.