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Different transcatheter strategies for aortic coarctation associated with patent ductus arteriosus
Anil Kumar Singhi1, Kothandam Sivakumar
1MIOT Centre for Children's Cardiac Care, MIOT Hospital, Manapakkam, Chennai, India. drkumarsiva@hotmail.com
Insights
Transcatheter interventions effectively manage aortic coarctation and patent ductus arteriosus in older patients. Treatment strategies are tailored to the specific anatomy of the coarctation and the size of the ductus arteriosus.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Aortic coarctation and patent ductus arteriosus (PDA) often coexist in older patients.
- Transcatheter interventions offer viable management options for this combined condition.
- Treatment strategies are contingent upon the specific anatomical features of the coarctation and the PDA size.
Background:
Older patients with combination of aortic coarctation and large patent ductus arteriosus can be managed with transcatheter interventions. The strategies depend on anatomy of coarctation and size of ductus arteriosus.
Methods:
We present three different patients with this combination. The anatomic factors like isthmic hypoplasia, dilatation of post coarctation descending aorta and size of ductus arteriosus were noted.
Results:
Patients with isthmic hypoplasia needed stent angioplasty of the coarctation. If there is no dilatation of post coarctation aorta, a single covered stent excluded the ductus arteriosus and relieved the coarctation gradients. Dilated post coarctation aorta precluded a covered stent and warranted closure of duct with occluder device and stent angioplasty of coarctation. When there is a good sized aortic isthmus in a discrete membranous coarctation, device closure of the duct and balloon aortoplasty was successful.
Conclusions:
In coarctation with patent ductus arteriosus associated with good sized aortic isthmus, closure of duct with duct occluder device and balloon aortoplasty would correct the lesions. If there is isthmic hypoplasia, device closure of the duct and stenting of the coarctation is needed. Covered stent is a reasonable alternative only in presence of non dilated descending aorta.
