Two-stage hybrid treatment strategy for an adult patient with aortic arch coarctation, poststenotic aneurysm, and hypoplastic left subclavian artery

Abstract

Rationale:Coarctation of aorta in adulthood is usually complicated by other cardiovascular anomalies, posing great technical challenge for intervention.Patient concerns:Here, we report an extremely rare case of aortic arch coarctation combined with a poststenotic biloculated calcified aneurysm and hypoplastic left subclavian artery.Interventions:First, an extra-anatomic bypass was established, along with narrowing of aorta just proximal and distal to the aneurysm. While the bypass graft significantly relieved trans-coarctation gradient, the latter procedure decreased intra-aneurysm pressure and created landing zones for aneurysm occlusion. Six months later, 2 muscular ventricular septal defect occluders were deployed at the proximal and distal orifice of the aneurysm.Outcomes:Follow-up computed tomography angiography confirmed the absence of contrast leakage into aneurysm.Conclusions:A 2-stage hybrid approach described here appears to be feasible, safe, and associated with favorable clinical outcomes in the treatment of complicated aortic coarctation and poststenotic aneurysm.

Saccular “Cauliflower” aneurysm of coarctation of aorta: a hybrid management

“…There is another case with two-stage hybrid management for an adult patient with a large single aortic arch aneurysm that was located at the greater curvature close to left subclavian artery, and was complicated by aortic arch coarctation. 1 This is similar to our case where the aneurysm was located at the greater curvature as well. Endovascular approach, such as percutaneous balloon dilatation and stent implantation, is not suitable in cases with extensive calcification and is associated with higher procedural risk of aortic rupture.…”

“…Endovascular approach, such as percutaneous balloon dilatation and stent implantation, is not suitable in cases with extensive calcification and is associated with higher procedural risk of aortic rupture. 1 Our patient was young and did not have any calcifications and thus, the hybrid approach was utilised. The stenotic left subclavian artery was intimately associated with the aortic arch aneurysms and thus, the combined surgical/endovascular approach was utilised for this patient.…”

“…Often, coarctation diagnosed later in life have associated vascular pathology. 1 Late aneurysm formation in the proximal or distal aortic arch is a well-recognised sequela of untreated coarctation, and it is associated with an increased risk of aortic rupture and death. 2 Presence of aneurysm in patients with coarctation of the aorta has management challenges and poses high risk of aortic rupture.…”