Paediatric midaortic syndrome associated with ascending aortic and renal aneurysm managed with complex multidisciplinary medical management and surgical repair.

We present the case of an otherwise previously healthy female in middle childhood with severe renovascular hypertension secondary to midaortic syndrome with ascending aortic dilation. She presented with hypertensive emergency (>200/100 mm Hg) and a marked blood pressure gradient between upper and lower extremities. She underwent successful surgical revascularisation by way of aorto-aortic bypass with a polytetrafluoroethylene graft and revascularisation of the superior mesenteric artery and both renal arteries by way of reimplantation for refractory hypertension despite four antihypertensives (ie, amlodipine, metoprolol, losartan and transdermal clonidine). At 18 months postoperatively, she is normotensive with a single agent, losartan, and has resolution of both left ventricular hypertrophy and symptoms. She follows with her multidisciplinary team with surveillance renal duplex and echocardiogram two times per year.