Percutaneous Intervention of Coarctation of Aorta in an Adult Man Presenting With Congestive Heart Failure

Keywords: ascending aorta aneurysm, balloon angioplasty, coarctation of aorta

A 52-year-old diabetic, hypertensive male presented with progressive dyspnea and palpitation for the last 3 months. Clinical examination revealed low blood pressure in lower limbs with an ankle-brachial index (ABI) of 0.50. Systemic examination revealed bilateral basal crepitations and left ventricle (LV) third-heart sound. An electrocardiogram showed atrial fibrillation with ventricular rate of 120 bpm. Two-dimensional echocardiography revealed LV ejection fraction of 30%, global LV hypokinesia, no mitral regurgitation, and normal tricuspid aortic valve. The ascending aorta was dilated, having a maximum dimension of 5.75 cm (Figure 1A). The suprasternal view showed a coarcted segment of the descending thoracic aorta (DTA) distal to the origin of the left subclavian artery (Figure 1B). A computed tomography angiography revealed aneurysmal dilation of calcified ascending aorta (Figure 1C) having a maximum dimension of 69.5 mm (Figure 1D). The DTA showed >95% focal narrowing suggestive of coarctation of aorta (CoA) (Figure 1D). There were extensive arterial collaterals from both internal thoracic arteries (Figure 1E).     

Following the medical treatment for LV failure and fast ventricular rate, catheterization was performed. Coronary angiography was normal. The ascending aorta was dilated and calcified. An aortic arch angiogram showed CoA (Figure 1F) having a gradient of 80 mm Hg. A 0.035-inch, straight, hydrophilic-tip guidewire could cross across the coarcted segment through left radial access. It was sequentially dilated with 6 x 40-mm followed by 12 x 40-mm peripheral angioplasty balloons (Cook Medical) (Figure 1G). Post angioplasty, there was no residual gradient and a brisk flow was achieved across the DTA (Figure 1H; Video Series). He had symptomatic improvement at 6-month follow-up exam. The open surgical aortic arch repair was not performed, as the patient was not willing to undergo further intervention.

Affiliations and Disclosures

From the ¹Department of Cardiology, ²Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 26, 2022.

Address for correspondence: Rajesh Vijayvergiya, MD, DM, FSCAI, FACC, FESC, FISES, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh – 160 012, India. Email rajeshvijay999@hotmail.com

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