Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 346 AFRICA Challenging paediatric coarctation cases treated with a hybrid approach: five-year follow up Sonia El-Saiedi, Hossam Hassanein, Ashraf Abdel-Rahim, Mohamed Maher, Ahmed Abdel-Wahed, Wael Attia Abstract Two paediatric patients suffering from recurrent coarctation after native coarctation surgery were scheduled for cardiac catheterisation in a hybrid setting by the age of two and three years. Through a right anterior mini-thoracotomy, unmounted stents were successfully placed in the coarctant segment. One-year follow up did not show echocardiographic improvement but the patients were controlled on medical therapy. Five-year follow up showed stent breakage in the first case, while the second showed stent stenosis that needed balloon dilatation. Keywords: hybrid, stent, aortic coarctation, vascular access Submitted 23/9/20, accepted 23/2/21 Published online 4/5/21 Cardiovasc J Afr 2021; 32 : 346–349 www.cvja.co.za DOI: 10.5830/CVJA-2021-006 Isolated coarctation of the aorta (CoA) is a common congenital heart disease easily correctable in the neonatal period or in childhood using different surgical approaches. 1 Recurrent coarctation (re-CoA) is a common phenomenon that may follow surgical repair. 2 The first-line treatment of re-CoA is percutaneous transluminal angioplasty (PTA) 3 but in cases with long narrow segments of re-CoA, PTA is not effective, with a high incidence of restenosis during the first year. 3 A more definitive method to relieve obstruction is stenting the narrow segment by implanting a stent that is expandable as the body grows. 4 Such procedures are not easy to perform in infants and young children whose vessels are small compared to the large-delivery catheters required for the procedure. A hybrid technique for stent implantation with access via the ascending aorta has been introduced to solve such problems. 5 Case reports Case 1: long-segment retrocardiac coarctation A female patient presented with recurrent chest infections by the age of one year. Her weight was 9 kg. Chest X-ray showed cardiomegaly and echocardiography revealed a dilated left ventricle (LV) with marked impairment of LV systolic function as the LV end-diastolic diameter (LVEDD) was 45.5 cm ( Z -score 7.2) and fractional shortening (FS) was 15%. Shewas referred to our cardiomyopathy clinic and examination showed a non-palpable femoral pulse. Echocardiography confirmed the diagnosis of dilated cardiomyopathy. There was no evidence of coarctation but there was a small descending aorta at the level of the diaphragm. Multi-slice CT angiography (MSCT) was done, revealing a tight long segment of coarctation in the mid-thoracic aorta (Fig. 1). Surgical correction was done at the age of 15 months (Fig. 2). However, she continued to need frequent admissions for heart failure and chest infections. Follow-up MSCT two months after surgery revealed the recurrence of a short coarctation segment, with poor LV systolic function. By the age of two years, her weight was 10 kg and she was scheduled for cardiac catheterisation. The femoral artery was too small to be cannulated by a 4-F sheath therefore we attempted Pediatric Cardiology Division, Pediatric Department, Cairo University, Cairo, Egypt Sonia El-Saiedi, PhD, myheartclinic@windowslive.com Ahmed Abdel-Wahed, MSc Wael Attia, PhD Cardiothoracic Surgery Department, Cairo University, Cairo, Egypt Hossam Hassanein, PhD Anesthesia Department, Cairo University, Cairo, Egypt Ashraf Abdel-Rahim, PhD Mohamed Maher, PhD Fig. 1. MSCT showing coarctation in the mid-thoracic aorta.