Descending Thoracic Aorta Stenosis Treated by Percutaneous Transluminal Angioplasty and Stenting with Coaxial Sheath Introduction Technique in a Small Child

A 10-year-old girl (23 kg) having a medical history of uncontrolled hypertension was presented to our hospital because of acute left heart failure. Transthoracic echocardiography showed stenosis of descending thoracic aorta with a maximum trans-stenotic pressure gradient of 50 mmHg and severe left ventricular systolic dysfunction with an ejection fraction of 20%. She was diagnosed with Takayasu arteritis with a long severe stenosis of segment III of the thoracic aorta. The procedure of percutaneous transluminal angioplasty was performed and helped to reduce the pressure gradient significantly. After a 6-month follow-up, the left ventricular function was unimproved. Hence, aortic angiography was done and revealed the descending thoracic aorta restenosis with a pressure gradient of 46 mmHg. Despite the difficulties of small vascular access and the disease severity, this patient was intervened by cover stent without any complications. The trans-stenotic pressure gradient decreased remarkably to 5 mmHg. The stent implantation should be considered in the severe stenosis of descending thoracic aorta because of its benefit and safety.