Reversible left ventricular dysfunction due to severe stenosis of the elephant trunk graft: A case report

Acquired coarctation of the aorta (CoA) following total aortic arch replacement (TAR) is a rare complication inducing left ventricular (LV) dysfunction probably due to increased LV afterload and secondary hypertension caused by increased upper body and decreased renal blood flow. We describe a case of a 35-year-old male who developed atypical CoA with severe LV dysfunction with LV ejection fraction of 10%, but without secondary hypertension after TAR using conventional elephant trunk (ET) technique for acute aortic dissection. Computed tomography revealed near-occlusive CoA due to narrowed distal ET. Because the myocardial histological findings were mild, and he had no cardiac failure history, we determined that LV function might be reversible. He underwent thoracic endovascular aortic repair (TEVAR), resulting in restored LV function. However, as the descending aortic false lumen distally to the end of ET was rapidly dilated, probably due to increased cardiac output and lower body blood flow, he underwent descending aortic replacement 3 months after TEVAR. In conclusion, a narrowed distal ET may cause LV dysfunction early after TAR, even without secondary hypertension. TEVAR may be a useful therapeutic option for a narrowed distant ET but can induce distal aortic dilatation. <Learning objective: A 35-year-old male demonstrated that acquired coarctation of the aorta due to a narrowed distant elephant trunk led to left ventricular (LV) dysfunction with comparable severity of dilated cardiomyopathy even with normal blood pressure. Thoracic endovascular aortic repair is an effective treatment option to restore LV function by decreasing LV afterload. However, a narrowed distal ET relief with an increased cardiac output might cause distal aortic dilatation.>