TRANSCATHETER STENTING OF SEVERE COARCTATION OF AORTA -TECHNIQUE TO PRESERVE FLOW TO LEFT SUBCLAVIAN ARTERY

In adolescent and adults, coarctation presents with systemic hypertension with radio-femoral pulse delay and stenting of coarctation is now accepted modality of treatment even in native coarctation, and defiantly in post-operative recoarctation. Otherwise his aortic valve was trifoliate and there were no atrial or ventricular septal defect or patent ductus arteriosus. Coarct segment was crossed with 6F MPA catheter and Aortogram done with pigtail 6F which showed tight coarctation just distal to leftSubclavian artery. 39mm covered CP Stent (Numed) mounted on 14mm x40mm VACS-III balloon & upper 40% of stent was manually uncovered to allow flow to leftSubclavian artery. At follow up after two weeks his echo showed well placed coarctation stent (as shown in fig-3) with residual PG of 15 mmHg and pulsatile flow abdominal aorta and preserve flow in leftSubclavian artery. Treatment options include surgical repair, balloon angioplasty or stenting of coarctation segment1. The only viable option in this case scenario was to partially but very precisely remove the cover of covered CP shunt to allow dilatation of coarctation segment in covered stent but allow flow to leftsubclavian artery through the upper uncover part of stent. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Mehboob Sultan, Maad Ullah, Nadeem Sadiq, Amjad Mehmood, Hajira Akbar, Asif Akbar Shah, Intisar Ul Haq Armed Forces Institute of Cardiology/ National Institute of Heart Disease/ National University of Medical Sciences (NUMS) Rawalpindi, Pakistan Correspondence: Dr Mehboob Sultan, Armed Forces Institute of Cardiology/ NIHD...