Aortic coarctation – interventional treatment in extreme forms in children

Introduction: Aortic coarctation is a vascular malformation characterized by the narrowing of the aorta. Interventional treatment is targeted at any age with the possibility of angioplasty (limited) even in young or infants. However, after the child exceeds the weight of 20 kg, it is acceptable to treat the coarctation by implanting a stent. In many of these cases, the aortic lumen is reduced to a diameter of 1-2 mm, sometimes even less, and the blood flow in the lower half of the body is achieved by extremely rich collateral circulation. The crossing of the coarctation area characterized by fibrosis and variable anatomical forms in order to implant the stent can be extremely difficult.
Methods: We present particularities of aortic coarcta-tion stenting in a number of cases (10 cases) of aortic coarctation of which some extreme forms (near atre-sia), manifested by severe arterial hypertension, at the age of adolescence. The implantation of the coated metallic stent was performed either by anterograde approach using initial radial vascular access, or by the application of crossing techniques of stenoses from co-ronary interventional cardiology. Extremely important were angioCT examinations previously performed, which allowed the technical preparation of these cases.
Several cases with severe aortic coarctation are pre-sented. After the confirmed ecocardiographic clinical diagnosis, there were indications of extreme severity of coarctation. In order to make an optimal therapeutic decision, angio CT assessment was performed, which allowed the choice of the approach type (interventi-onal stenosis) and allowed the preparation of the ne-cessary materials, anticipating and preventing various periprocedural complications. A transversal secondary approach (right and left) in a few cases, followed by la-shes capture and guide fitting, were the starting point for the procedures. The end result was very good in all cases after the CP Covered Stent implantation of 39-45 mm.
Conclusions: The extreme forms of aorta coarctation are relatively rare, but very good results can be obtained by combining the techniques of traversing, pre-dilation, stenting and post-dilation. In atresic aortic coarctation forms it may be necessary to perforate the area of coarctation/atresia by radiofrequency.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)