The present disclosure relates to semiconductor structures and, more particularly, to middle of the line self-aligned direct pattern contacts and methods of manufacture. The structures described herein include: at least one gate structure with a metallization and source/drain regions; a source/drain contact in electrical connection with the source/drain regions, respectively; and a contact structure with a re-entrant profile in electrical connection with the source/drain contact and the metallization of the at least one gate structure, respectively.