A 16-year-old adolescent girl was referred to our tertiary care center for management of a failed aortic valve balloon dilatation procedure for congenital valvular aortic stenosis. The medical records revealed a residual peak-to-peak gradient of 80 mm Hg after 2 dilations with 16 x 6-mm Tyshak balloon (NuMed Inc.).

The mainstay of treatment of pediatric aortic coarctation is open surgery. One option for repair includes subclavian flap aortoplasty, first described by Waldhausen and Nahrwold in 1966. Within this technique, several modifications have been made over the years as long-term follow-up data became available. Early outcomes revealed little concern for left upper extremity limb ischemia or subclavian steal syndrome. These complications are rare but can have a significantly delayed presentation years after coarctation repair. We present a case of subclavian steal syndrome with lifestyle-limiting vertebrobasilar symptoms experienced by a patient 36 years after subclavian flap aortoplasty for aortic coarctation.

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Aortic coarctation presenting with neurological complications as compressive myelopathy is rare. We report a case of a 43-year-old, hypertensive, female who presented with gradually progressive paraparesis over 4 years. She was diagnosed to be having coarctation of the aorta with intra-spinal collaterals causing compressive myelopathy. She underwent successful percutaneous endovascular implantation of a balloon-expandable aortic stent to relieve her aortic coarctation. This led to regression of her intra-spinal collaterals relieving her cord compression. This nonsurgical modality treatment proved to be safe and effective in relieving her hypertension and neurological complication of paraparesis.
UNASSIGNED: •To recognize that paraparesis can be a rare manifestation of coarctation of the aorta.•To highlight the importance of treating the primary pathology of coarctation of the aorta in such critically ill therapeutically challenging patients.

Concomitant replacement of the ascending aorta with the aortic valve in patients who have left ventricular dysfunction might carry high operative risks. Performing the conservative reduction aortoplasty was shown to have less complications in such patients. When combined with other concomitant cardiac procedures, the newly described \"spiral\" aortoplasty technique in this series allows for a mulitplanar wall tension reduction in moderately dilated ascending aorta.

BACKGROUND: Isolated, fusiform aneurysms, exclusively affecting the tubular portion of the ascending aorta, are rare. Surgical treatment aims to change their natural course, reducing individual and cumulative risks of rupture, dissection and death. Open tubular graft replacement still remains the procedure of choice, despite significant risks. In permanent pursuit for optimal, alternative surgical strategy in high-risk patients, less invasive and off-pump plicating ascending aortoplasty with modified external Dacron graft wrapping seems to be a reliable choice.
METHODS: Two (2) consecutive patients were operated on. The same preoperative calculations and slightly different operative techniques were applied regarding surgical exposure and wrapping graft orientation. Immediate and late follow-up (5 years) results were compared.
RESULTS: Absolute and indexed target ascending aortic diameters remained acceptable (<2.1cm/m2 considered the upper normal range for adults). There were no significant changes in proximal and distal aortic diameters. Ascending aortic silhouette on contrast enhanced multi-detector CT was better with Dacron wrapping graft tailored to have its grooves in the longitudinal direction. Upper mini-sternotomy was quite appropriate for this procedure, from a surgical point of view, and was safe for the patient.
CONCLUSIONS: Careful patient selection and using the current model of preoperative calculations and surgical technique resulted in acceptable and stable ascending aortoplasty in high-risk patients 5 years after surgery.

Balloon angioplasty of the stenosed aorta is usually a relatively simple, yet potentially a catastrophic procedure. Aortic rupture during aortoplasty, though uncommon, carries a high mortality. We report case of a 39-year-old female with aortoarteritis with multiple arterial stenoses whose infra-renal abdominal aorta ruptured during balloon dilatation of the stent deployed in that segment. The site of aortic rupture was temporarily occluded by low-pressure inflation of the same balloon and then was sealed using a stent-graft introduced by contra-lateral femoral arterial access.