Author + information
- Received December 7, 2017
- Accepted December 12, 2017
- Published online May 2, 2018.
- Omid Shafe, MD,
- Parham Sadeghipour, MD and
- Jamal Moosavi, MD∗ ()
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- ↵∗Address for correspondence:
Dr. Jamal Moosavi, Rajaie Cardiovascular Medical & Research Center, Vali-Asr Street adjacent to Mellat Park, Tehran, Iran.
A 60-year-old man with pleuritic chest pain, coughs, and 3 episodes of massive hemoptysis presented to our hospital’s emergency department. He had a history of surgical repair of coarctation of the aorta (CoA) 20 years earlier.
The patient was diagnosed with acute inferior myocardial infarction according to his electrocardiogram and rising cardiac enzymes. Nonetheless, this was not the whole story. Computed tomography angiography of the patient’s thoracic aorta revealed a large and ruptured pseudoaneurysm adjacent to the surgical graft between the left subclavian artery and the descending thoracic aorta (Figure 1).
In this emergent situation, after successful primary angioplasty of the occluded right coronary artery via right radial access (Figure 2), we effectively excluded the ruptured pseudoaneurysm of the graft insertion site and inevitably the graft itself by deploying covered CP Stents (NuMED Inc., Hopkinton, New York) (Figure 3). Thereafter, we attempted to perform stent coarctoplasty of the native CoA site using a long self-expandable bare-metal stent and eventually succeeded in inserting an occluder in the previous graft to prevent retrograde perfusion into the fistula or the pseudoaneurysm site (Figures 4 and 5). The final angiogram (Figure 6) as well as follow-up computed tomography angiography (Figure 7) showed no endoleak. Additionally, the patient’s clinical course was uneventful.
In the field of surgical or endovascular repair of CoA, it is not uncommon to encounter late complications such as recoarctation, dilatation, or dissection of the ascending or descending aorta, and formation of aortic pseudoaneurysms (1). Pseudoaneurysms following the surgical correction of CoA are likely to be a growing problem in the future. Aneurysm formation and rupture are responsible for approximately 7% of deaths (2). It is, therefore, important that these patients be maintained under lifetime surveillance including regular cross-sectional imaging.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 7, 2017.
- Accepted December 12, 2017.
- 2018 American College of Cardiology Foundation