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One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a
Xingwei He1,2, Menaka Dhuromsingh3, Wanjun Liu1,2
1Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
This case report details a novel one-stop transcatheter intervention for a rare combination of severe bicuspid aortic stenosis and coarctation of the aorta in an adult. The minimally invasive approach successfully treated both conditions, offering a new therapeutic option.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Adult Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) typically requires early correction; untreated adults often have poor outcomes.
- Concurrent severe bicuspid aortic stenosis (BAV) and CoA in adults is rare and poses significant management challenges.
- Traditional surgical repair may be unsuitable for high-risk patients with these combined conditions.
Observation:
- A 63-year-old female presented with uncontrolled hypertension, chest pain, and dyspnea.
- Diagnostic imaging revealed severe calcified BAV and a stenotic aortic coarctation.
- The patient underwent a successful one-stop interventional procedure using distinct vascular access for each defect.
Findings:
- A Cheatham-Platinum stent was deployed via the right femoral artery to address the coarctation.
- Transcatheter aortic valve replacement (TAVR) was performed via the left common carotid artery for the BAV.
- The patient was discharged asymptomatic and remained well at 1-year follow-up.
Implications:
- This case demonstrates the feasibility and efficacy of a combined, one-stop transcatheter approach for complex adult CoA and BAV.
- Minimally invasive transcatheter interventions offer a viable alternative to surgery for high-risk patients.
- This novel strategy expands therapeutic options for rare cardiovascular combinations, potentially improving patient outcomes.
Introduction:
Coarctation of the aorta (CoA) is usually diagnosed and corrected early in life. Most untreated patients with CoA usually die before 50 years of age. Adult patients with concomitant CoA and severe bicuspid aortic stenosis are relatively rare and present complex management challenges without standard guidelines.
Case Summary:
A 63-year-old female patient with uncontrolled hypertension was admitted due to chest pain and dyspnea upon exertion (NYHA grades III). Echocardiogram showed a severely calcified and stenotic bicuspid aortic valve (BAV). A severe stenotic calcified eccentric aortic coarctation 20 mm distal to the left subclavian artery (LSA) was discovered by computed tomography (CT) angiography. Following consultation with the cardiac team and patient willingness, we performed a one-stop interventional procedure to repair both defects. First, a cheatham-platinum (CP) stent was implanted via the right femoral access, immediately distal to the LSA. Due to the markedly twisted and angled descending aortic arch, we chose to perform transcatheter aortic valve replacement (TAVR) via the left common carotid artery. The patient was discharged and followed up for 1 year without symptoms.
Discussion:
Although surgery is still the main treatment for these diseases, it is not suitable for high-risk surgical patient. Transcatheter intervention for patients with severe aortic stenosis complicated with CoA simultaneously is rarely reported. The success of this procedure depends on the patient's vascular condition, the skills of the heart team, and the availability of the technical platform.
Conclusion:
Our case report demonstrates the feasibility and efficacy of a one-stop interventional procedure in an adult patient with concurrent severely calcified BAV and CoA via two different vascular approaches. Transcatheter intervention, in contrast to traditional surgical approaches or two-stop interventional procedures, as a minimally invasive and novel method, offers a wider range of therapeutic methods for such diseases.
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