Case Reports Transcatheter Treatment of ‘‘Complex’’ Aortic Coarctation Giuseppe Santoro, 1 * MD, Shakeel Qureshi, 2 MD, and Maria Giovanna Russo, 1 MD A young woman, submitted to aortic coarctation repair in early infancy, was referred with clinical and echocardiographic signs of severe recoarctation. Spiral CT scan confirmed the aortic isthmus obstruction but imaged also a huge aneurysm distal to the coarctation site, from which arose a large aberrant right subclavian artery. In cardiac catheterization, this vessel showed an upper-to-lower flow direction and its closure was deemed mandatory to abolish a major feeding source to the aneurys- mal sack. Thus, this anomalous vessel was occluded with an Amplatzer Duct Occluder device and multiple covered Cheatham-Platinum stents were telescopically implanted into the thoracic aorta to dilate the coarctation and exclude the aneu- rysm. In conclusion, percutaneous transcatheter treatment is feasible, safe, and cost-effective even in aortic arch obstructions with complex anatomic arrange- ment. V C 2010 Wiley-Liss, Inc. Key words: pediatric interventions; congenital heart disease in adults; complications adult cath/intervention INTRODUCTION Transcatheter approach is nowadays deemed feasible and cost-effective either in native or postsurgical aortic coarctation in adolescents or adults [1,2]. However, this approach is still challenging in complex anatomic arrangements because of near-atretic obstruction or long-segment aortic hypoplasia [3–6] or in the case of coexistence of aneurysm [7–12] or aberrant epiaortic vessels [13–16]. In particular, the association between aortic coarctation, isthmus aneurysm, and aberrant subclavian artery has been only seldom reported [17]. In this anatomic arrangement, covered stent implanta- tion may cause exclusion of the anomalous vessel, thereby resulting in peripheral ischemia. Thus, a com- plex surgical approach has been suggested [18], although this procedural complication may also be managed conservatively [19] or by percutaneous approach [20]. This article describes a never reported one-step transcatheter repair of a complex aortic recoarctation because of an associated huge thoracic aneurysm and aberrant right subclavian artery. In this patient, a throughout anatomic and patho-physiologic diagnostic work-up minimized the risks of the procedure allowing a better planning of the percutaneous approach. CASE REPORT A 34-year-old woman, submitted to aortic coarcta- tion repair with patch at the age of 4, was referred to our Unit for clinical evaluation of suspected aortic recoarctation. She reported very frequent, severe, and disabling systemic hypertensive crises that were resist- ant to pharmacologic therapy. Clinical and echocardio- graphic findings suggested the presence of a severe aortic recoarctation. Spiral CT scan imaged a severe narrowing of the aortic isthmus with a huge biloculated aneurysm distal to the coarctation site (Fig. 1A). In 1 Department of Cardiology, 2nd University of Naples,‘‘Monaldi’’ Hospital, Naples, Italy 2 Department of Paediatric Cardiology, Evelina Hospital, London, United Kigdom Conflict of interest: Nothing to report. *Correspondence to: Giuseppe Santoro, MD, Via Vito Lembo, 14, 84131, Salerno, Italy. E-mail: santoropino@tin.it Received 30 January 2010; Revision accepted 5 March 2010 DOI 10.1002/ccd.22542 Published online 14 April 2010 in Wiley InterScience (www. interscience.wiley.com) V C 2010 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 76:247–250 (2010)