Page 44 - Journal of Structural Heart Disease Volume 5, Issue 6

Case Report
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:268-273
DOI: https://doi.org/10.12945/j.jshd.2019.006.19
Received: February 14, 2019 Accepted: March 13, 2019 Published online: December 2019
Endovascular Treatment of Hypoplastic Gothic Aortic Arch in Combination With Congenital Absence of the Left Common Carotid Artery
Manolis Georgievich Pursanov, MD, PhD*, Mikhail Aramovich Abramyan, MD, PhD, Yurii Nikolaevich Shamrin, MD, PhD, Aleksei Vladimirovich Bedin,
Davronbek Bozorkulovich Pardaev, Ekaterina Nikolaevna Kabanova
Department of Emergency Cardiac Surgery and Interventional Cardiology, Morozov Children's City Clinical Hospital, Moscow, Russian Federation
Abstract
A rare clinical case of endovascular treatment of a hypoplastic Gothic aortic arch (AA) with congenital ab- sence of the left common carotid artery (CCA) in com- bination with ventricular septal defect (VSD) is pre- sented. In early childhood, the patient underwent VSD closure with an occluder and balloon dilatation of the AA and the aortic isthmus (AI). Currently, at the age of 10, large-diameter stent implantation in the hypoplas- tic AA and AI was performed. Thus, a radical correction of complex congenital heart disease was performed by three-stage endovascular treatment.
Copyright © 2019 Science International Corp.
Key Words
Aortic arch hypoplasia • Kinking • Left common carotid artery absence • Endovascular treatment
Introduction
Coarctation of the aorta is often associated with the hypoplasia of the aortic arch (AA), which may also occur along with other congenital heart defects. The AA is considered hypoplastic when the diameter of its proximal, distal and isthmic segments is less than 60%, 50%, and 40% of the ascending aorta diameter, respectively [1].
The hypoplastic segment of the AA leads to the appearance of a systolic pressure gradient (SPG) be- tween the ascending and descending aorta, which is the cause of the development of hypertension [2]. Long-Term prognosis in these patients is considered unfavorable since it is a common cause of death af- ter the fourth decade of life [3, 4]. The elimination or reduction of the SPG in the presence of narrowing/ hypoplasia of the AA and aortic isthmus (AI) improves long-term results and survival.
In newborns and infants, the standard treatment for hypoplastic AA is open surgery [3]. In elder chil- dren, surgical correction of the hypoplastic AA often requires the use of extracorporeal circulation with selective antegrade cerebral perfusion, circulatory arrest, and hypothermia. These factors are associat- ed with an increased risk of intra- and postoperative complications, as well as mortality.
Endovascular treatment options for AA coarctation and re-coarctation have been successfully used for many years. However, endovascular interventions on the AA remain technically challenging and, therefore, are rarely performed. In a number of studies [5-8] and case reports [4, 9], there are good immediate results of the AA stenting.
The absence of the left common carotid artery (CCA) is an extremely rare congenital anomaly, which
* Corresponding Author:
Manolis Georgievich Pursanov, MD, PhD
Department of Emergency Cardiac Surgery and Interventional Cardiology Morozov Children's City Clinical Hospital
Dobryninsky 4th pereulok, 1/9 (1a), Moscow, 121552, Russian Federation Tel. +8 495 414 78 89; Fax: +8 926 529 32 23; E-Mail: mpursanov@rambler.ru
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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