aortic coarctation is a congenital cardiovascular malformation that should be diagnosed and corrected early in life.1 ) survival of a patient to more than 70 years of age is extremely unusual in cases of uncorrected coarctation . there are a few case reports of patients who were first diagnosed with coarctation at a very late age,2 - 4 ) and their management remains controversial . we report a case of a woman who was first diagnosed with coarctation of the aorta at the age of 75 years and underwent a successful total simultaneous repair of coarctation and severe aortic valve stenosis . a 75-year - old woman was referred to our emergency room because of squeezing pain in the chest and dyspnea ( new york heart association class iii ) . she had a medical history of uncontrolled hypertension for 10 years and was diagnosed with aortic valve stenosis 5 years ago at a local hospital . on physical examination , on echocardiography , severe degenerative aortic valve stenosis , concentric left ventricular hypertrophy and normal left ventricular systolic function were observed . the peak and mean pressure gradient of the aortic valve were estimated at 140 mm hg and 80 mm hg , respectively . therefore , an aortic valve replacement was planned and coronary angiography was performed with aortography for evaluation of chest pain and uncontrolled blood pressure despite antihypertensive drug medication . coronary angiography revealed normal coronary arteries , while aortography showed severe stenosis of the descending aorta just below the origin of the left subclavian artery ( fig . severe aortic coarctation and compensatory dilatation of the intercostal and internal thoracic arteries were noted ( fig . the blood pressure was 170/80 mm hg in both upper arms , and 90/60 mm hg in the lower extremities . the patient underwent a single - stage correction of the coarctation and aortic valve stenosis . after a median sternotomy , cardiopulmonary bypass was established through cannulation of the aortic arch and the right atrium . after retrograde cold blood cardioplegic arrest and incision of the ascending aorta , the calcified bicuspid aortic valve was excised , and a porcine tissue valve prosthesis ( 21 mm , hancock ii ; medtronic inc , minneapolis , mn , usa ) was inserted . afterwards , the supracoronary ascending aorta was anastomosed with a 14 mm polytetrafluoroethylene graft ( gore - tex vascular graft ; w.l gore & associates inc , flagstaff , az , usa ) by an end - to - side technique . and then through a posterior pericardial approach , a final end - to - side anastomosis between the bypass graft and the descending aorta completed the repair ( fig . the cardiopulmonary bypass and aortic cross - clamp times were 224 minutes and 163 minutes , respectively . aortic coarctation , which is usually diagnosed and corrected early in life , accounts for approximately 9% of all congenital cardiovascular malformations.1 ) prognosis of an unrepaired coarctation is very unfavorable . another 5% die at 50 - 60 years and the remaining 5% die at an even older age.2 ) death in these patients is usually secondary to heart failure , coronary artery disease , aortic rupture / dissection , concomitant aortic valve disease , infective endarteritis / endocarditis , or cerebral hemorrhage.2)3 ) a review of the literature over the past 30 years revealed 10 cases over 70 years of age who were first diagnosed with uncorrected aortic coarctation . although surgery is considered the treatment of choice for aortic coarctation in children and adults , management strategies for older patients are controversial and there is no consensus on the management of these patients . one patient underwent successful coarctation repair4 ) and one patient died during surgical repair.5 ) two patients underwent coronary artery bypass graft surgery for myocardial ischemia without coarctation repair6)7 ) and another five patients were conservatively managed for heart failure and hypertension . although one might argue that highly developed collateral circulation might allow elderly patients to tolerate the coarctation without its surgical repair,8 - 12 ) there are benefits associated with symptomatic improvement and with blood pressure reduction after surgical repair in patients older than 50 years.13 ) a direct approach to coarctation repair may come across difficulties in the adult population , and a large collateral formation and lung failure after thoracotomy may present technical challenges while total aortic crossclamping , with diminished collaterals , has been involved as a causal factor in paraplegia . for these reasons , extra - anatomic bypass grafting has been used as an alternative surgical option.14 ) severe coarctation of the aorta in combination with intracardiac pathology such as severe valvular stenosis or regurgitation and coronary artery disease in elderly patients requires surgery . the simultaneous operative management of both lesions is desirable because of the higher morbidity and mortality associated with staged procedures , and there has been only one reported case of a patient older than 70 years of age who underwent extra - anatomic bypass and simultaneous correction of intracardiac pathology.14 ) we considered coarctation repair surgery because of the highpressure gradient ( 80 mm hg ) between the ascending and descending aorta and the markedly uncontrolled hypertension despite antihypertensive drugs . because two - stage procedures for aortic valve replacement and coarctation repair are associated with high rates of perioperative morbidity and mortality , we performed a onestage total simultaneous repair of the coarctation and aortic valve replacement . after surgical intervention , blood pressure was well controlled with minimal doses of antihypertensive medication . in conclusion , patients with aortic coarctation rarely survive till old age for their first diagnosis . as this case illustrates , simultaneous repair of coarctation of the aorta in combination with an intracardiac pathology can be safely and successfully done even in elderly patients .
aortic coarctation is usually diagnosed and repaired in childhood and early adulthood . 
 survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual , and management strategies for these cases remain controversial . 
 we present a case of a 75-year - old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one - stage repair involving valve replacement and insertion of an extra - anatomical bypass graft from the ascending to the descending aorta .