EuroIntervention image in cardiology: percutaneous repair of severe coarctation of the aorta
Consult this interventional cardiology image on percutaneous repair of severe coarctation of the aorta from the December 2016 issue of EuroIntervention Volume 12 Number 12.
AuthorsSinjini Biswas1, MBBS; Leeanne Grigg1, MBBS; Lucas Eastaugh2, MBBS; Ronen Gurvitch1, MBBS; William Wilson1*, MBBS
A 21-year-old asymptomatic male was referred with severe hypertension. Blood pressure was 190/100 mmHg in both arms. Examination revealed absent femoral and pedal pulses. Electrocardiography showed sinus rhythm with left ventricular hypertrophy. Echocardiography demonstrated moderate left ventricular hypertrophy with a tri-leaflet aortic valve. Computed tomographic aortography (CTA) demonstrated severe discrete coarctation with a diameter of <1 mm at the aortic isthmus (Panel A), and invasive aortography (via dual injections) demonstrated complete aortic occlusion (Panel B).
Transcatheter intervention was performed via both radial and femoral arterial access (Moving image 1). The occlusion was crossed from above with an exchange length 0.035-inch straight wire (Terumo Corp., Tokyo, Japan), which was snared in the descending aorta (EN Snare®, 12-20 mm; Merit Medical, Galway, Ireland) and externalised to allow delivery of a 14 Fr Mullins sheath (Medtronic, Dublin, Ireland). An 8-zig 45 mm covered Cheatham-Platinum stent (NuMED, Hopkinton, NY, USA) was deployed on a 16 mm balloon without predilation. The invasive peak-peak gradient dropped from 60 to 0 mmHg. At one year, the patient remains well and is normotensive on one antihypertensive agent. Repeat CTA confirmed no aortic wall injury (Panel C).
(Panel A) Computed tomographic aortography (CTA) demonstrated severe discrete coarctation with a diameter of 1 mm at the aortic isthmus, (Panel B) and invasive aortography (via dual injections) demonstrated complete aortic occlusion, (Panel C) at one year, the patient remains well and is normotensive on one antihypertensive agent. Repeat CTA confirmed no aortic wall injury.
Moving image 1: video demonstrating percutaneous intervention on the coarctation of the aorta.
Conflict of interest statement
The authors have no conflicts of interest to declare.
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Cardiology, Royal Children’s Hospital, Melbourne, Australia