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

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 349 can reach adult size in the future. 7 Our concern was that our patients would soon need more surgery to remove the small stent and perform another repair. Surgical re-intervention in such cases may carry the risk of many complications, 7 which may be difficult to tolerate in our myopathic or hypertensive patients. Conclusion Recently, hybrid stenting of the aortic coarctation has become safer due to advances in stent and balloon catheter design, even in low birth-weight neonates. 8 Hybrid procedures allowed us to access the aorta and insert a stent that could reach adult size, needing only balloon dilatations. This would buy the patient a few more years, giving the myocardium a chance to recover. We chose a right anterior mini-thoracotomy approach for direct access of the ascending aorta. This approach is also used in some centres for managing very low birth-weight infants with coarctation who represent a high surgical risk when using coronary stents. 8-10 References 1. Tabry IF, Zachariah ZP. Right thoracotomy approach for repair of recurrent or complex coarctation of the aorta using an extra-anatomic ascending aorta to descending aorta bypass graft off-pump. Multimed Man Cardiothorac Surg 2013; 2013 : 21. 2. Koletsis E, Ekonomidis S, Panagopoulos N, Tsaousis G, Crockett J, Panagiotou M. Two stage hybrid approach for complex aortic coarcta- tion repair. J Cardiothorac Surg 2009: 4 : 10. 3. Porras D, Brown DW, Marshall AC, del Nido P, Bacha EA, McElhinney DB. Factors associated with subsequent arch reintervention after initial balloon aortoplasty in patients with Norwood procedure and arch obstruction. J Am Coll Cardiol 2011; 58 (8): 868–876. 4. Haas NA, Happel CM, Blanz U, Laser KT, Kantzis M, Kececioglu D, Sandica E. Intraoperative hybrid stenting of recurrent coarctation and arch hypoplasia with large stents in patients with univentricular hearts. In J Cardiol 2016; 204 : 156–163. 5. Pursanov MG, Svobodov AA, Levchenko EG, Atajanov UU. New approach for hybrid stenting of the aortic arch in low weight children. J Struct Heart Dis 2017; 3 (5): 147–151. 6. Magee AG, Brzezinska-Rajszys G, Qureshi SA, Rosenthal E, Zubzycka M, Ksiazyk, Tynan M. Stent implantation for aortic coarctation and recoarctation . Heart 1999; 82 : 600–606. 7. Kutty S, Burke RP, Hannan RL, Zahn EM. Hybrid aortic reconstruc- tion for treatment of recurrent aortic obstruction after stage 1 single ventricle palliation: medium term outcomes and results of regulation. Catheter Cardiovasc Interv 2011; 78 (1): 93–100. 8. Gorenflo M, Boshoff D, Heying R, Eyskens B, Rega F, Meyns B, Gewillig M. Bailout stenting for critical coarctation in premature/criti- cal/complex/early recoarcted neonates. Catheter Cardiovasc Interv 2010; 75 : 553–561. 9. Radtke WA, Waller BR, Hebra A, Bradley S. Palliative stent implanta- tion for aortic coarctation in premature infants weighing < 1.500 g. Am J Cardiol 2002; 90 : 1409–1412. 10. Cools B, Meyns B, Gewillig M. Hybrid stenting of aortic coarctation in very low birth weight premature infant. Catheter Cardiovasc Interv 2013; 81 (4): E195–198. Fig. 8. Balloon dilatation for stent stenosis. A. Aortic arch injection showing the stenosed stent. B. Balloon dilata- tion of the stenosed stent. A B