Stent implantation for coarctation of the aorta in a premature infant through carotid cutdown as a bridge to surgical correction

Abstract

Isolated coarctation of the aorta accounts for 5% to 10% of all congenital heart defects. Neonatal repair is typically surgical at our institution. Stent implantation for coarctation is typically reserved for older children in whom a larger-caliber stent can be used that can potentially be postdilated to adult diameters. We report a case of stent implantation for native coarctation as a bridge to successful surgical repair in an extremely preterm infant. CLINICAL SUMMARY The patient was a male infant born at 25 weeks’ gestation because of preterm labor. Birth weight was 875 g. After delivery, the patient was noted to have a large patent ductus arteriosus (PDA). He underwent PDA ligation on day of life 6 through a left thoracotomy with multiple clips. After PDA ligation, he had significant upper extremity hypertension. Repeat echocardiographic analysis demonstrated severe aortic coarctation with a Doppler-predicted 58 mm Hg gradient. He was transferred to our institution for further care. Echocardiographic analysis at our institution confirmed the diagnosis. The patient remained severely hypertensive, with systolic blood pressures ranging from 97 to 118 mm Hg in the upper extremities and 35 to 47 mm Hg in the lower extremities with evidence of end-organ hypoperfusion. A carotid cutdown was performed in the cardiac catheterization laboratory, and a 4F sheath was placed in the right internal carotid artery. Angiographic analysis revealed a discrete coarctation adjacent to the ductal clips (Figure 1). The transverse aortic arch measured 3.5 mm, narrowing to 1.04 mm in the region of the coarctation. The descending aorta