Aortic stenting for neonatal coarctation of the aorta : when should this be considered?

Abstract

Aortic coarctation (CoA) constitutes the fifth most common congenital heart defect (1 in 2500 live births). This lesion comprises 5-8% of congenital heart disease and has variable severity and mode of presentation. Critical coarctation in newborns usually presents with severe narrowing of the upper thoracic aorta below the isthmus and adjacent to the arterial duct, and is dependent on duct patency for survival. Rapid deterioration of the patient usually results from spontaneous closure of the patent arterial duct (PDA). This deterioration is in part due to reduced renal perfusion resulting in fluid and acid retention causing heart failure and metabolic acidosis. This may be alleviated by the administration of intravenous prostaglandin, with temporary improvement of distal aortic blood flow, and overall condition. The treatment of choice is surgical resection with the ‘extended end-to-end’ technique. We present a case of a severely ill newborn with complex coarctation, multiorgan failure, disseminated intravascular coagulation and oedema, who was treated with emergency stenting on the tenth day of life. This was followed by surgical stent removal and repair of the arch on the 29th day of life. We followed the strategy of minimally invasive interventional bridging of a borderline patient with regard to the experience of stenting of native coarctations in older patients, or complex recurrent stenosis of previously surgically treated children