Abstract
In this report, we describe the case of a 28-year-old male who presented to our hospital with shortness of breath and sudden, severe central chest pain that radiated across his chest and back. The patient had a history of coarctation of the aorta (CoA) repair using Dacron patch aortoplasty at the age of 10 years, and he had been lost to clinical follow-up. A chest X-ray (CXR) revealed the widening of the upper mediastinum. He underwent emergency CT angiography, which demonstrated extensive mediastinal hematoma and contrast leaking from a 4x12 cm complex pseudoaneurysm of the proximal thoracic descending aorta. After the heart-team meeting, the transcatheter approach was deemed more feasible and safer than a surgical approach. The patient was taken to cardiac catheterization laboratory and, under general anaesthesia, we successfully implanted a tapered (28 mm - 26 mm) x 150 mm Valiant Thoracic Stent Graft with the Captivia Delivery System (Medtronic Vascular, Santa Rosa, CA). In this case, we demonstrated the feasibility and safety of using a stent graft to treat late surgical complications after CoA repair, which are not uncommon.
Highlights
Coarctation of the aorta (CoA) is the sixth most common congenital heart disease (CHD), accounting for 48% of all CHD
The patient had a history of coarctation of the aorta (CoA) repair using Dacron patch aortoplasty at the age of 10 years, and he had been lost to clinical follow-up
We demonstrated the feasibility and safety of using a stent graft to treat late surgical complications after CoA repair, which are not uncommon
Summary
Coarctation of the aorta (CoA) is the sixth most common congenital heart disease (CHD), accounting for 48% of all CHD. Irrespective of the kind of surgical technique used initially, late post-repair complications are not uncommon, and often occur decades later Such complications include hypertension, re-CoA, and aneurysm/pseudoaneurysm formation. Any surgical technique can lead to late pseudoaneurysm formation at the anastomotic site (around 10% of cases overall), longer-term follow-up suggests that there is a particular problem with patch aortoplasty. He underwent emergency CT angiography, which demonstrated extensive mediastinal hematoma and contrast leaking from a 4x12 cm complex pseudoaneurysm of the proximal thoracic descending aorta (Figure 2). The intimal disruption started about 2 cm distal to the origin of the left subclavian artery (LSCA), which was probably the site of the patch repair. The sketch shows intimal flap at the site of disruption (red arrow), large pseudoaneurysm (blue arrow), and aortic true lumen compression (green arrow) We usually do such sketches to plan our approach (roadmap). A followup CT angiography revealed a widely patent stent graft with no endoleaks
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