Mid-aortic syndrome: a rare cause of heart failure in infants

Area of Science:

• Cardiology
• Pediatric Cardiology
• Vascular Surgery

Background:

• Mid-aortic syndrome (MAS) is a rare congenital condition characterized by narrowing of the aorta, potentially leading to severe hypertension and heart failure in infants.
• Early diagnosis of MAS is crucial but challenging, as symptoms can mimic other pediatric cardiac diseases like dilated cardiomyopathy.
• This report focuses on thoracoabdominal aortic coarctation, a severe form of MAS, in two infants.

Observation:

• Two infants, aged 2 and 11 months, presented with severe heart failure and were initially misdiagnosed.
• Diagnostic imaging was essential in confirming the correct diagnosis of critical thoracoabdominal aortic coarctation.
• Both patients underwent interventional procedures: one with balloon angioplasty alone, the other with balloon angioplasty and bare-metal stent implantation.

Findings:

• The patient treated solely with balloon angioplasty experienced a fatal outcome post-procedure.
• The infant who received balloon angioplasty with stent implantation demonstrated a positive recovery.
• Physical examination findings, including blood pressure differentials and pulse palpation, are vital for diagnosing unexplained infant heart failure.

Implications:

• Prompt and accurate diagnosis of MAS in infants is critical for timely intervention and improved prognosis.
• Stent implantation appears to be a potentially safer and more effective therapeutic strategy compared to balloon angioplasty alone in pediatric MAS cases.
• Heightened clinical suspicion and thorough physical examinations are paramount in identifying MAS in infants presenting with heart failure symptoms.