Catheter Interventional Creation of a “Double Aortic Arch” for Treatment of a Complex Residual Coarctation of the Aorta

We report on a 22 year old male with hypoplastic aortic arch and ventricular septal defect after corrective surgery and implantation of a 14mm Dacron conduit from the ascending (AoA) to descending aorta (AoD). The patient was hypertensive (150/70 mmHg). At catheterization he had significant peak systolic pressure gradient between AoA and AoD and an aneurysmatic contrast medium extravasation at the site of the Dacron conduit (Panel A, *). Additionally the native hypoplastic aortic arch was depicted with a tortuous course (Panel B). After four previous operations surgery on the aorta seemed to be associated with significant risk. Hence, the aneurysm was sealed with a 22 mm covered CP-stent and the native arch was stented with a covered premounted Advanta 41 mm V12 stent to a width of 4 mm initially (Panel C). After 6 months the Advanta stent was expanded to 10 mm with an Atlas high-pressure balloon. Another Advanta 29 mm V 12 stent was placed distally (Panel D). The peak invasive pressure gradient was reduced to 8 mmHg. In conclusion we report on successful interventional treatment of complex re-coarctation by creation of a functionally double aortic arch. If the arterial hypertension persists, the “native” aortic arch may be expanded further.