Endovascular occlusion of an aortic coarctation after thoracic endovascular aortic repair of an anastomotic aneurysm

Özet

A 58-year-old man with a history of aortic and mitral mechanical valve replacement was referred to our hospital for symptomatic chronic heart failure. In 1988, he had undergone opensurgical correction of an isthmic aortic coarctation (CoA), with the creation of an extra-anatomic bypass from the left subclavian artery to the descending thoracic aorta. The followingfindings were found: severe mitral valve failure with perivalvular leakage, severe aortic valvestenosis, pulmonary hypertension, distal anastomotic aneurysm with the apparent occlusion of the CoA. A thoracic endovascular aneurysm repair was performed. A postoperativehigh-pressure leak with no evident signs of ineffective sealing was observed. Computed tomography angiography (CTA) 3D reconstruction demonstrated the recanalization of the CoA.A second procedure was planned. The CoA was anterogradely cannulated. Three coils weredeployed into the aneurysmal sac, followed by a vascular plug, positioned on the coarctationconduit, but it failed to anchor and dislocated into the sac. A second plug was deployed, but italso partially dislocated. Finally, a patent foramen ovale occluder device was deployed to occlude the communication. The final angiogram showed the complete occlusion of the coarctation and correction of the leak, which was confirmed by a 6-month post-operative CTA.