Percutaneous exclusion of a false aneurysm of the left subclavian artery after coarctectomy
W Budts*, M Gewillig**
* Department of Cardiology, Adult Congenital Cardiology, ** Department of Pediatrics, Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
A 43-year old male underwent a coarctectomy (Dacron graft interposition 16 mm) at the age of 12 years. Because of a stenosis, the surgeon also performed a plasty on the proximal left subclavian artery. No follow-up data of this patient were available in his medical records and therefore, he was invited for a routine control at the outpatient clinic of adult congenital heart disease. Although he had no complaints the upper mediastinum was enlarged on chest X-ray (figure 1a). Magnetic resonance revealed a huge false aneurysm of the left subclavian artery and a residual coarcatation at the level of the previous graft interposition (figure 1b). To avoid a new thoracotomy an interventional approach was worked out. Distal from the false aneurysm, the left subclavian artery was occluded by a 10 mm Amplatzer PDA occluder. The orifice of the left subclavian artery was sealed by a covered stent (10 ZIG 6 cm CP Stent on a 18 mm BIB balloon), which also partially dilated the residual coarctation. An angiogram in the aortic arch documented a total exclusion of the false aneurysm (figure 1c). Sufficient blood supply of the left arm was provided by reversed flow in the left vertebral artery. The exclusion of the aneurysm was also documented by contrast computer tomography (figure 1d). This case underlines the importance of the follow-up of patients who underwent a coarctectomy and the possibilities of percutaneous interventional procedures.
Figure legend
Figure 1a: Chest X-ray 30 years after coarctectomy. The shadow of the upper mediastinum was enlarged (single arrow).
Figure 1b: Magnetic resonance of the thoracic aorta. A huge false aneurysm of the left subclavian artery (single arrow) and a residual coarcatation at the level of the previous Dacron graft interposition (double arrow) were found.
Figure 1c: Angiogram of the aortic arch after occluding the distal left subclavian artery by an Amplatzer duct occluder (singe arrow) and after sealing the orifice of the subclavian artery by a covered stent (covered CP Stent) (double arrow). FA: false aneurysm; AA: ascending aorta; DA: descending aorta.
Figure 1d: Computerized tomogram with contrast after the exclusion procedure of the false aneurysm (FA). No residual contrast filling was found in the FA.
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