Postoperative esophageal achalasia after repair of aortic coarctation synchronized with bilateral subclavian artery aneurysm: case report

INTRODUCTION: The coexistence of aortic coarctation and subclavian artery aneurysm is rare, with bilateral involvement being exceptionally uncommon. The association of aortic coarctation with achalasia has not been previously reported. Neurological injury during aortic arch surgery is a known risk factor for vocal cord paralysis and may theoretically disrupt esophageal motility. CASE PRESENTATION: A 30-year-old male, who had undergone repair of aortic coarctation 13 years prior, presented with worsening neck pain and dyspnea. Imaging revealed a large, progressive right subclavian artery aneurysm (5.8 cm) compressing the trachea and esophagus, a smaller left subclavian aneurysm (2.1 cm), and esophageal dilation with a tapered distal end consistent with achalasia. The patient also had left vocal cord paralysis, indicating recurrent laryngeal nerve injury from the initial surgery. Due to the high rupture risk, the right subclavian aneurysm was surgically repaired via a bypass graft from the right common carotid artery. CONCLUSION: This is the first reported case linking aortic coarctation repair with the subsequent development of achalasia, likely due to intraoperative vagus nerve injury. It highlights the importance of meticulous nerve preservation during aortic arch surgery and considering neurological causes of dysphagia in post-surgical patients.