Coarctation Stenting When Origin of Aberrant Right Subclavian Artery Is Before Stenotic Segment
Parag Bhalgat1, Neeta Bachani2, Bharat Dalvi3
1Sujyot Heart Clinic, Mumbai, India.
Insights
Undiagnosed coarctation of the aorta (CoA) can lead to adult left ventricular dysfunction. This case highlights managing CoA with an unusual aberrant right subclavian artery (ARSA) during transcatheter intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) can present in adulthood with left ventricular dysfunction.
- Anatomical variations in neck vessels complicate CoA management.
- Delayed diagnosis of CoA can occur, sometimes mistaken for other conditions like peripartum cardiomyopathy.
Observation:
- A patient with a history of double-outlet right ventricle repair was diagnosed with CoA via echocardiography.
- During transcatheter intervention for CoA, an aberrant right subclavian artery (ARSA) was identified arising proximal to the coarctation.
- The aberrant right subclavian artery (ARSA) originated opposite the left subclavian artery.
Findings:
- Successful transcatheter stenting of the coarctation of the aorta (CoA) was achieved.
- The stenting procedure preserved flow through both subclavian arteries, including the aberrant right subclavian artery (ARSA).
- The aberrant right subclavian artery (ARSA) in this case was proximal to the coarctation, differing from the usual distal anatomy.
Implications:
- Accurate pre-procedural imaging and analysis of neck vessel anatomy are crucial for successful stenting.
- Preventing "jailing" of aberrant vessels during stenting is essential for maintaining adequate blood flow.
- This case underscores the importance of considering atypical vascular anatomy in complex congenital heart disease interventions.
Background:
Occasionally, coarctation of the aorta (CoA) may go unnoticed and present in adulthood with left ventricular dysfunction. Variations in anatomy of the neck vessels can add to the complexity in management.
Case Summary:
Our patient underwent surgical repair of a double-outlet right ventricle during which CoA was overlooked. She presented later with peripartum "cardiomyopathy" when CoA was diagnosed on 2-dimensional echocardiography. During transcatheter intervention, an aberrant right subclavian artery (ARSA) was seen arising before CoA opposite the origin of the left subclavian artery. The CoA was successfully treated with a bare metal stent without compromising the flow through either of the subclavian arteries.
Discussion:
ARSA is present in 1% of the population and usually arises distal to CoA, unlike in this case, where ARSA was proximal to the coarct.
Take-Home Message:
Diligent analysis of the origin of neck vessels is mandatory to plan and prevent them from jailing during stenting.
Related Concept Videos
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
01:26Aneurysm III: Interprofessional Care