Miniinvasive interventional bridge to major surgical repair of critical aortic coarctation in a newborn with severe multiorgan failure.

Abstract

We present a case of a severely ill newborn with complex coarctation, multiorgan failure and massive oedema, who was treated with emergency stenting of the isthmus on the second day of life, which was followed by surgical stent removal and repair of the arch on the 29th day, after stabilization of his general status. Interventional percutaneous direct stent implantation was performed, using a coronary stent (Abbott Multi-Link Vision Coronary Stent 3.5 mm/15 mm, USA) to cover the area of the aortic isthmus in the newborn. The area from the origin of the left subclavian artery to the beginning of the descending thoracic aorta beneath the isthmus was widely expanded. Control angiography showed normal size of the isthmus without a systolic gradient in the area. In the next 3 weeks the boy improved his general status, with normalization of liver and renal parameters, as well as resolution of the oedema, and underwent surgery on his 29th day of life. The procedure of stent removal with aortic extended end-to-end anastomosis was performed without complications, and the infant was transferred to general paediatrics for further treatment. The strategy of miniinvasive interventional bridge to postpone major surgical repair was effective in the presented infant, with positive final results of both cardiological intervention and subsequent surgical repair.

Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation

“…However, in patients with CoA, even years after successful treatment of the narrowing, increased morbidity and mortality have remained major issues. In a broad age range various problems exist, including (exercise) hypertension and heart failure, and are not yet sufficiently understood [6–10]. …”

Indications for stenting of coarctation of the aorta in children under 3 months of age

“…Depending on the duration of the impairment, recovery may take some time before the stent can be surgically removed [11]. In a previously described case, multi-organ failure recovered completely after coarctation stenting in a newborn, which could be operated successfully 4 weeks later [6]. We used a short stent, because during a coarctectomy typically a short aortic segment has to be removed anyway, and we did not want to extend the operation, i.e.…”

“…Stenting of coarctation of the aorta (CoA) is well established in adults and children weighing more than 25 kg, but even in smaller children this technique is gaining acceptance [1,2]. In smaller children aged 3 months or more, ballooning is a treatment option for native and recurrent CoA [3], but there are recent reports of even smaller patients undergoing stent therapy as either a bridge to operation or as primary treatment [4][5][6][7][8][9]. Stenting of coarctations in small children has been carried out for several reasons in a limited number of patients [4][5][6][7][8]10].…”

Operative treatment of tetralogy of Fallot with concomitant correction of anomalous origin of the left pulmonary artery from Kommerell’s diverticulum

“…The option of simultaneous intracardiac defect correction with pulmonary artery bed reconstruction was in our opinion more efficient than off pump LPA implantation to the pulmonary trunk [ 3 ]. A reasonable argument was that primary recruitment of pulmonary arteries should create optimal conditions for later complete ToF repair, according to our institutional experience [ 7 , 8 ]. We believe that early diagnosis of discontinuous pulmonary artery would be crucial for choosing the optimal operative strategy, although our patient was referred to the institution as an emergency case, at the given age [ 9 , 10 ].…”