Single-stage surgical repair of undiagnosed adult aortic coarctation with concomitant aortic root pathology and coronary artery disease: a case report.

INTRODUCTION AND IMPORTANCE: Coarctation of the aorta (CoA) is usually diagnosed in childhood, although delayed adult presentation may mimic acquired cardiovascular disease and result in advanced secondary cardiac complications. This case highlights the diagnostic challenges and surgical management of this uncommon presentation. CASE PRESENTATION: A 42-year-old man presented with progressive heart failure and recurrent chest pain. Evaluation revealed previously undiagnosed severe CoA associated with a 5.5-cm ascending aortic aneurysm, severe aortic regurgitation, and significant left anterior descending artery in-stent restenosis. The patient underwent successful single-stage repair comprising extra-anatomic bypass, aortic root replacement, and coronary artery bypass grafting, with an uncomplicated postoperative course and marked clinical improvement. CLINICAL DISCUSSION: Adult CoA may remain undiagnosed until secondary cardiovascular complications dominate the clinical presentation. In selected patients requiring concomitant cardiac surgery, a single-stage strategy can provide definitive anatomical and physiological correction while avoiding staged interventions. CONCLUSION: This case highlights the significance of considering adult CoA in patients with unexplained complicated cardiovascular disease. Early recognition and appropriate patient selection allow effective single-stage surgical intervention in meticulously selected instances.