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One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report

INTRODUCTION: Coarctation of the aorta (CoA) is usually diagnosed and corrected early in life. Most untreated patients with CoA usually die before 50 years of age. Adult patients with concomitant CoA and severe bicuspid aortic stenosis are relatively rare and present complex management challenges wi...

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Autores principales: He, Xingwei, Dhuromsingh, Menaka, Liu, Wanjun, Zhou, Qiang, Zeng, Hesong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10192622/
https://www.ncbi.nlm.nih.gov/pubmed/37215553
http://dx.doi.org/10.3389/fcvm.2023.1162203
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author He, Xingwei
Dhuromsingh, Menaka
Liu, Wanjun
Zhou, Qiang
Zeng, Hesong
author_facet He, Xingwei
Dhuromsingh, Menaka
Liu, Wanjun
Zhou, Qiang
Zeng, Hesong
author_sort He, Xingwei
collection PubMed
description INTRODUCTION: Coarctation of the aorta (CoA) is usually diagnosed and corrected early in life. Most untreated patients with CoA usually die before 50 years of age. Adult patients with concomitant CoA and severe bicuspid aortic stenosis are relatively rare and present complex management challenges without standard guidelines. CASE SUMMARY: A 63-year-old female patient with uncontrolled hypertension was admitted due to chest pain and dyspnea upon exertion (NYHA grades III). Echocardiogram showed a severely calcified and stenotic bicuspid aortic valve (BAV). A severe stenotic calcified eccentric aortic coarctation 20 mm distal to the left subclavian artery (LSA) was discovered by computed tomography (CT) angiography. Following consultation with the cardiac team and patient willingness, we performed a one-stop interventional procedure to repair both defects. First, a cheatham-platinum (CP) stent was implanted via the right femoral access, immediately distal to the LSA. Due to the markedly twisted and angled descending aortic arch, we chose to perform transcatheter aortic valve replacement (TAVR) via the left common carotid artery. The patient was discharged and followed up for 1 year without symptoms. DISCUSSION: Although surgery is still the main treatment for these diseases, it is not suitable for high-risk surgical patient. Transcatheter intervention for patients with severe aortic stenosis complicated with CoA simultaneously is rarely reported. The success of this procedure depends on the patient's vascular condition, the skills of the heart team, and the availability of the technical platform. CONCLUSION: Our case report demonstrates the feasibility and efficacy of a one-stop interventional procedure in an adult patient with concurrent severely calcified BAV and CoA via two different vascular approaches. Transcatheter intervention, in contrast to traditional surgical approaches or two-stop interventional procedures, as a minimally invasive and novel method, offers a wider range of therapeutic methods for such diseases.
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spelling pubmed-101926222023-05-19 One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report He, Xingwei Dhuromsingh, Menaka Liu, Wanjun Zhou, Qiang Zeng, Hesong Front Cardiovasc Med Cardiovascular Medicine INTRODUCTION: Coarctation of the aorta (CoA) is usually diagnosed and corrected early in life. Most untreated patients with CoA usually die before 50 years of age. Adult patients with concomitant CoA and severe bicuspid aortic stenosis are relatively rare and present complex management challenges without standard guidelines. CASE SUMMARY: A 63-year-old female patient with uncontrolled hypertension was admitted due to chest pain and dyspnea upon exertion (NYHA grades III). Echocardiogram showed a severely calcified and stenotic bicuspid aortic valve (BAV). A severe stenotic calcified eccentric aortic coarctation 20 mm distal to the left subclavian artery (LSA) was discovered by computed tomography (CT) angiography. Following consultation with the cardiac team and patient willingness, we performed a one-stop interventional procedure to repair both defects. First, a cheatham-platinum (CP) stent was implanted via the right femoral access, immediately distal to the LSA. Due to the markedly twisted and angled descending aortic arch, we chose to perform transcatheter aortic valve replacement (TAVR) via the left common carotid artery. The patient was discharged and followed up for 1 year without symptoms. DISCUSSION: Although surgery is still the main treatment for these diseases, it is not suitable for high-risk surgical patient. Transcatheter intervention for patients with severe aortic stenosis complicated with CoA simultaneously is rarely reported. The success of this procedure depends on the patient's vascular condition, the skills of the heart team, and the availability of the technical platform. CONCLUSION: Our case report demonstrates the feasibility and efficacy of a one-stop interventional procedure in an adult patient with concurrent severely calcified BAV and CoA via two different vascular approaches. Transcatheter intervention, in contrast to traditional surgical approaches or two-stop interventional procedures, as a minimally invasive and novel method, offers a wider range of therapeutic methods for such diseases. Frontiers Media S.A. 2023-05-04 /pmc/articles/PMC10192622/ /pubmed/37215553 http://dx.doi.org/10.3389/fcvm.2023.1162203 Text en © 2023 He, Dhuromsingh, Liu, Zhou and Zeng. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
He, Xingwei
Dhuromsingh, Menaka
Liu, Wanjun
Zhou, Qiang
Zeng, Hesong
One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
title One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
title_full One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
title_fullStr One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
title_full_unstemmed One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
title_short One-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
title_sort one-stop interventional procedure for bicuspid aortic stenosis in a patient with coexisting aortic coarctation: a case report
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10192622/
https://www.ncbi.nlm.nih.gov/pubmed/37215553
http://dx.doi.org/10.3389/fcvm.2023.1162203
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