Page 21 - Journal of Structural Heart Disease Volume 3, Issue 5

Case Report
Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:147-151
DOI: https://doi.org/10.12945/j.jshd.2017.020.17
Received: April 25, 2017 Accepted: June 13, 2017 Published online: October 2017
New Approach for Hybrid Stenting of the Aortic
Arch in Low Weight Children
Manolis Georgievich Pursanov, MD*, Andrey Andreevitch Svobodov, MD, Elena Grigoryevna Levchenko, MD, Ulugbek Urazbayevitch Atajanov, MD
Bakoulev Scienti c Center for Cardiovascular Surgery, Moscow, Russian Federation
Abstract
We present the rst case of hybrid stenting of coarcta- tion of the aorta using a retrograde approach through the descending aorta. An 8-month-old, 5.7 kg infant developed severe obstructive lesion of the aortic arch and isthmus after primary correction of the common arterial trunk and surgical management of coarctation of the aorta. As a result, emergency intervention was needed. Taking into the account the low body weight of the patient and the impossibility of using a transfem- oral approach, we decided to obtain access through a 6th intercostal space posterolateral thoracotomy to advance a 6-F guiding catheter to the descending aor- ta via counter-aperture. After implantation of a Va- leo stent, there were no complications, and complete elimination of the obstruction was achieved. This case demonstrates that a retrograde hybrid stenting tech- nique via the descending thoracic aorta for aortic isth- mus and arch obstruction produces good anatomical and hemodynamic results and can be applied in cases with no other alternative.
Copyright © 2017 Science International Corp.
Key Words
Coarctation/recoarctation of the aorta • Hybrid stenting • Low weight children
Introduction
Recurrent obstructive lesions of the arch and isth- mus of the aorta are common complications after re- constructive operations in patients with hypoplastic
left heart syndrome, interrupted aortic arch, or hypo- plasia of the aortic arch as well as patients with com- plex congenital heart disease [1, 2]. The main method of treatment of aortic recoarctation in young children is percutaneous transluminal angioplasty (PTA) [3-6]. However, PTA is not e ective in patients with long narrowed segments of the aortic arch, and a high in- cidence of restenosis occurs during the rst year after the procedure [7, 8]. A more radical method is stent- ing of the aortic arch and isthmus via implantation of a stent that can be expanded as the body grows [9]. However, it is not possible to perform such a percuta- neous procedure in infants and young children due to their small vessels and the large delivery catheters needed for the procedure [10, 11]. To overcome these di culties, a hybrid technique for stent implantation via access through the ascending aorta has been in- troduced [9, 12]. However, implementation of this technique is possible only when sternotomy is per- formed.
Case Presentation
Patient O. (2.7 kg) was admitted to the clinic at 4 days of age in critical condition, with common arterial trunk, coarctation of the aorta, and patent ductus arte- riosus. Given the state of the child, a decision was made to resolve the condition. An operation was performed through a posterior-lateral thoracotomy. Coarctation of the aorta was shown by a hypoplastic isthmus of the aorta. The contracted site was resected through a
* Corresponding Author:
Manolis Georgievich Pursanov, MD
Bakoulev Scienti c Center for Cardiovascular Surgery
Rublevskoe Shosse 135, Moscow 121552, Russian Federation
Tel.: +8 495 414 78 89; Fax: +8 926 529 3223; E-Mail: mpursanov@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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