Middle Aortic Syndrome Repair in a 14-Month-Old Child: A 24-Year Case Study.

We present the 24-year follow-up of a patient treated for mid-aortic syndrome (MAS) in early childhood, highlighting the role of surgical and endovascular techniques in long-term management. A 14-month-old male with severe hypertension and recurrent cardiac failure was diagnosed with juxta-diaphragmatic aortic coarctation. He underwent an aorto-aortic thoracoabdominal bypass using an 8 mm polytetrafluoroethylene graft, which resolved his symptoms. At age 14, he developed exercise-induced claudication due to outgrowing the graft. Endovascular recanalization of the native aorta with a 9 × 59 mm covered stent restored distal perfusion. One year later, stent compression was successfully treated with a 12 × 40 mm bare metal stent. At age 24, the patient remains asymptomatic, normotensive, and physically active, with normal ankle-brachial indices. Imaging revealed a widely patent native aorta and occlusion of the original bypass, with normal distal perfusion confirmed by pulse volume recordings. This case underscores the importance of early diagnosis, well-planned surgical intervention, and long-term surveillance in MAS. The successful outcome highlights the complementary roles of surgical and endovascular approaches in achieving durable clinical results.