Surgical treatment of a distal arch pseudoaneurysm and migrated stent-graft after interrupted aortic arch repair

A 13-year-old girl, who had undergone a modified Blalock-Park operation using an equine pericardial patch for a type A aortic arch interruption at 10 days of age, and patch repair of a ventricular septal defect at 1 year, presented with recurrent stenosis of the aorta. She underwent balloon angioplasty which resulted in a pseudoaneurysm at the distal suture line of the patch. Endovascular stent-grafting was employed. Soon after placement, the stent-graft had migrated into the distal portion of the descending aorta. The distal aortic arch and proximal descending thoracic aorta were replaced with a prosthetic graft. The migrated stent-graft was removed. The operation was performed through an anterior approach under hypothermic circulatory arrest and selective cerebral perfusion. The postoperative course was uneventful. The migration was likely caused by the limited ability to bend the stent-graft to match the curvature of the arch, the stiffness of the scarred equine pericardial patch, and the shape of the aorta.