Transcatheter therapy for aortic coarctation with severe systemic hypertension during pregnancy

Assaïdi, Anass; Sbragia, Pascal; Fraisse, Alain

doi:10.1002/ccd.24404

Cited by 11 publications

(19 citation statements)

References 12 publications

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“…Rest of the pregnancy of their patient was uneventful [9]. They pointed out a need for randomized trials for confirming the safety of stenting during pregnancy [9]. Our patient's blood pressure remained high after stenting and she even needed antihypertensives.…”

Section: Internal Medicine Section Abstractmentioning

confidence: 69%

“…Zeira and Zohar reported 2 pregnant women with coarctations who were also medically followed-up until their deliveries [8]. However, Assaidi et al, reported a case in which they had implanted a stent for coarctation of aorta during pregnancy, without complications [9]. Rest of the pregnancy of their patient was uneventful [9].…”

Section: Internal Medicine Section Abstractmentioning

confidence: 99%

“…However, Assaidi et al, reported a case in which they had implanted a stent for coarctation of aorta during pregnancy, without complications [9]. Rest of the pregnancy of their patient was uneventful [9]. They pointed out a need for randomized trials for confirming the safety of stenting during pregnancy [9].…”

Section: Internal Medicine Section Abstractmentioning

confidence: 99%

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Single Therapeutic Catheterization for Treatment of Late Diagnosed Native Coarctation of Aorta Using A Covered Stent

Ural

Caglar

Çağlar

et al. 2014

JCDR

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A 35-year-old, white, 6-months pregnant woman presented to our department for hypertension. She had hypertension since 17 years. She had leg pain on excursion since 5 years. She had given birth 4 times without complications and had 2 miscarriages. Her physical examination revealed weak femoral pulses and a brachiofemoral delay. Blood pressures of right and left arm and leg were 190/110 mmHg, 140/ 90 mmHg, and 80/50 mmHg, respectively. A grade 3/6 systolic murmur was heard over the precordial and interscapular areas. The electrocardiogram was normal. Standard and Doppler echocardiographic findings revealed a coarctation of descending aorta with a maximum 84 mmHg gradient across the coarctation, which was distal to the left subclavian artery [Table/ Fig-1].MRI angiography was planned, but as the patient was pregnant and did not have serious complications nor heart failure symptoms, it was postponed to after her delivery. The patient had an uneventful pregnancy and she gave birth successfully by caesarean section without any haemodynamic complications, and the newborn was healthy. After baby's birth, the patient's blood pressure remained high. MRI angiography which was performed after birth; showed a strict coarctation of aorta (CoA) in the proximal part of the descending aorta [Table/ Fig-2]. The length of the coarctation of aorta was 14 mm, isthmus was 19 mm, smallest diameter of aortic coarctation was 6 mm, and post-coarctation aortic diameter was 28 mm.Cardiac catheterization was performed under local anaesthesia and left femoral artery and vein were cannulated. The coarctation segment could not be crossed with a 0.035 diagnostic guide wire. Therefore, a 0.014 hydrophilic guide wire was used for crossing the coarctation segment. Diagnostic multiple pores and a pigtail catheter were passed across the coarctation, over the hydrophilic guide wire. Measurements of aorta and coarctation segment were similar, as seen on MRI angiography. The maximal gradient across the coarctation was 64 mmHg. Distal part of the coarctation was minimally dilated (28 mm) [Table/ Fig-3]. Pigtail catheter was changed to a 14F, 85 cm long Mullins sheath over the 0.035 exchange guide wire. A custom made, eight-zig, 4.5 mm long CP covered stent (NuMed, Hopkinton, NY) which was loaded on a balloon in balloon (BIB) (inner balloon 12 mm × 4,5 cm, outer balloon 24 mm × 5.5 cm) was used. After attachment, the excess covering material was folded around the stent. The graft stent and balloon assembly was passed through the sheath, after checking for correct positioning. Firstly, the inner balloon was inflated and its position was rechecked by angiography and then the outer balloon was fully inflated [Table / Fig-4].Both balloons were then deflated, with the inner one being deflated first before being withdrawn through the sheath. Control aortography revealed a stent-graft in position, which covered the coarcted segment. Maximum gradient across the coarctation was 11 mmHg. The coarcted segment's diameter was increased from 6 mm to 17 mm. The proce...

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Section: Internal Medicine Section Abstractmentioning

confidence: 69%

Section: Internal Medicine Section Abstractmentioning

confidence: 99%

See 1 more Smart Citation

Single Therapeutic Catheterization for Treatment of Late Diagnosed Native Coarctation of Aorta Using A Covered Stent

Ural

Caglar

Çağlar

et al. 2014

JCDR

View full text Add to dashboard Cite

show abstract

“…Uncontrolled hypertension may lead to neonatal and maternal adverse events [3]. Percutaneous treatment of severe coarctation with uncontrolled hypertension has been described during pregnancy [4]. However, in our patient, medical therapy successfully controlled the hypertension, allowing interventional therapy to be postponed until after delivery, and avoiding the use of radiation and general anesthesia during pregnancy.…”

Section: Commentmentioning

confidence: 71%

Aortic Coarctation Diagnosed During Pregnancy in a Woman With Repaired Tetralogy of Fallot

Jalal

Iriart

Thambo

2015

The Annals of Thoracic Surgery

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Aortic coarctation is thought to be a rare condition in patients with tetralogy of Fallot. We report the case of a 26 year old woman presenting with systemic hypertension at 17 weeks of pregnancy after repair of tetralogy of Fallot in childhood. Echocardiography and magnetic resonance imaging revealed right aortic arch with severe isthmic coarctation. Her blood pressure was controlled medically during the rest of her pregnancy, and delivery was uneventful. Successful transcatheter placement of a covered stent at the level of the coarctation was performed after delivery. To our knowledge, this is the first reported case of aortic coarctation diagnosed in an adult patient late after repair of tetralogy of Fallot.

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“…It is known that aortic disease is more aggressive during pregnancy. The mechanism includes increased wall stress from hyperdynamic cardiovascular changes, particularly from 12 to 28 weeks gestation, and oestrogen-induced aortic media degeneration [ 1 , 3 ]. Sometimes, adult CoA may be first diagnosed during pregnancy, necessitating emergency surgery [ 1 ], as in the present case.…”

Section: Discussionmentioning

confidence: 99%

Case report: a novel approach for the emergency repair of acute aortic rupture associated with congenital aortic Coarctation

Wang

Huang

et al. 2021

J Cardiothorac Surg

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Background Congenital aortic coarctation (CoA) associated with aortic rupture is a rare but extremely lethal condition. In pregnant patients, the condition becomes very risky. Case presentation We presented a case of a pregnant (20 weeks gestation) patient with CoA associated with ruptured aortic pseudoaneurysm who was successfully rescued using a novel hybrid strategy. Conclusions This hybrid approach may be a life-saving bridging intervention in patients with CoA associated with devastating complications, such as ruptured aneurysms, especially with extremely narrowed access.

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Transcatheter therapy for aortic coarctation with severe systemic hypertension during pregnancy

Cited by 11 publications

References 12 publications

Single Therapeutic Catheterization for Treatment of Late Diagnosed Native Coarctation of Aorta Using A Covered Stent

Single Therapeutic Catheterization for Treatment of Late Diagnosed Native Coarctation of Aorta Using A Covered Stent

Aortic Coarctation Diagnosed During Pregnancy in a Woman With Repaired Tetralogy of Fallot

Case report: a novel approach for the emergency repair of acute aortic rupture associated with congenital aortic Coarctation

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