Percutaneous recanalization and balloon angioplasty of congenital isolated local atresia of the aortic isthmus in adults

Abstract

Congenital isolated local atresia of the aortic isthmus is anatomically similar and morphogenetically related to congenital coarctation of the aorta and was encountered in 4 out of 26 consecutive adult patients selected for coarctation angioplasty at our center. Anterograde recanalization of the atresia was safely and successfully accomplished in all four patients, using a brachial approach. Balloon dilation in the four patients, with ancillary stent implantation in one patient, resulted in reduction of translesion gradient from 84 +/- 11 mm Hg to 9 +/- 7 mm Hg without complications. Angiography in the three non-stented patients after a mean follow-up of 13 months showed no evidence of restenosis, dissection or aneurysm formation, though one patient had mild dilatation of the posterior aspect of the aortic isthmus. The clinical presentation of patients with isolated local aortic atresia, and their short- to mid-term response to percutaneous treatment, is similar to that of patients with isolated severe coarctation of aorta.

Transcatheter treatment of interrupted arcus aorta in two adolescents

“…In aortic arch atresia, either there is a local complete obliteration of the lumen or a segment of the aortic arch is converted into a fibrous cord, with a big gap instead of a distal connection. In the absence of a part of the aortic arch segment it is impossible to treat it by transcatheter methods, but in cases with membranous atresia transcatheter treatment as described in this text is possible (6,7).…”

Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents

“…Even membranous atresia is reported to be treatable with interventional perforation and dilatation [9]. However, restenosis remains of concern.…”

Recanalization of a discrete atretic right pulmonary artery segment with a new radiofrequency system

“…This novel approach has potential application in selected cases of "atretic congenital coarctation of the aorta" [16] and acquired occlusion of peripheral vessels due to previous catheterization. The new Baylis/Nykanen RF system may facilitate perforation procedures due to several advantageous features: the system is easy and simple to use, the RF catheter has a low profile, is soft, flexible, and steerable, and the whole system allows for maintenance of catheter position and further wire exchanges due its coaxial design.…”