Aortic Valve Stenosis and Insufficiency Combined With Aortic Coarctation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe aortic valve disease and aortic coarctation (n=1). Intervention: Single-session transcatheter approach (balloon angioplasty, TAVR, and CP stent implantation). Primary outcome: Hemodynamic improvement and symptom resolution.

Tao Hu; Weiling Tu; Linfeng Li

doi:10.1016/j.jaccas.2025.106415

November 24, 2025JACC Case ReportsOpen Access

Aortic Valve Stenosis and Insufficiency Combined With Aortic Coarctation

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Key result

Single-session combined TAVR, angioplasty, and stenting achieves immediate hemodynamic and symptom relief.

n=1

Why the study?

The coexistence of aortic valve stenosis and regurgitation with native coarctation is a rare and complex condition in adults, especially those with significant surgical risks, complicating management.

Does a single-session transcatheter approach improve hemodynamics and clinical symptoms in a high-risk patient with combined aortic valve disease and aortic coarctation?

Key Points

To report the feasibility and clinical efficacy of a unified, single-session transcatheter approach for an adult patient presenting with concurrent aortic valve disease and native aortic coarctation.
A 60-year-old male with poorly controlled hypertension, chronic kidney disease, atrial fibrillation, and an STS risk score of 9.13% was evaluated by a multidisciplinary heart team.
A three-step single-session transcatheter procedure was performed: balloon angioplasty (8 × 120 mm balloon at 12 atm), transcatheter aortic valve replacement with a 27-mm self-expanding valve, and covered Cheatham-Platinum stent implantation under transesophageal echocardiography guidance.
The total procedure time was approximately 2 hours with no acute complications, achieving a final aortic valve velocity gradient of 1.3 m/s with trace paravalvular leak.
Hemodynamic status improved immediately, allowing blood pressure normalization without antihypertensive medications and discharge on postoperative day 7.
At 1-month follow-up, the patient demonstrated complete resolution of symptoms, controlled blood pressure, and a prosthetic valve peak gradient of 1.9 m/s with mild paravalvular leak.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does a single-session transcatheter approach improve hemodynamics and clinical symptoms in a high-risk patient with combined aortic valve disease and aortic coarctation?

P

Population

A 60-year-old male with severe bicuspid aortic valve disease, native aortic coarctation, and prohibitive surgical risk who was treated and followed for 1 month.

I

Intervention

Single-session transcatheter 'one-stop' strategy combining coarctation balloon angioplasty, transcatheter aortic valve replacement (TAVR) with a 27-mm self-expanding valve, and Cheatham-Platinum (CP) covered stent implantation at the coarctation site.

O

Outcome

Hemodynamic improvement and symptom resolution at 1-month follow-up.

A single-session combined transcatheter strategy (balloon angioplasty, TAVR, and stent implantation) offers a safe, effective, and minimally invasive alternative for high-risk adults presenting with coexisting severe aortic valve disease and aortic coarctation.

Limitations

Further experience and long-term follow-up are needed to validate this approach.
Bicuspid anatomy combined with coarctation increases complexity in device delivery and valve sizing.
Potential challenges include contrast-induced nephropathy or vascular complications.
Single case report
Further experience and long-term follow-up are needed to validate the approach

Implication

May inform management of rare combined aortic lesions in prohibitive-risk patients; leaves open durability, generalizability, and need for prospective data.

Abstract

BACKGROUND: The coexistence of aortic valve stenosis and regurgitation with native coarctation is a rare and complex condition in adults, especially those with significant surgical risks, complicating management. CASE SUMMARY: A 60-year-old male with poorly controlled hypertension, chronic kidney disease, and atrial fibrillation presented with progressive dyspnea and chest tightness. Echocardiography revealed a bicuspid aortic valve with moderate stenosis and regurgitation, reduced ejection fraction, and left ventricular dilation. Computed tomography showed near-occlusive coarctation of the descending aorta. Given high surgical risk, conventional surgery was deemed unfeasible. DISCUSSION: A single-session transcatheter "one-stop" approach, combining balloon angioplasty, aortic valve replacement, and stent implantation, was performed, resulting in immediate hemodynamic improvement. TAKE-HOME MESSAGE: A unified, single-session transcatheter strategy offers a safe and effective alternative for high-risk patients with aortic valve disease and coarctation.

Discussion

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Published by JACC Case Reports · CC BY-NC-ND

Cite This Study

Hu et al. (2025) conducted a case report in Severe aortic valve disease and aortic coarctation (n=1). Single-session transcatheter approach (balloon angioplasty, TAVR, and CP stent implantation) was evaluated on Hemodynamic improvement and symptom resolution. A unified, single-session transcatheter strategy combining balloon angioplasty, aortic valve replacement, and stent implantation successfully achieved immediate hemodynamic improvement and symptom resolution in a high-risk patient.

synapsesocial.com/papers/6a142e2840803be22f8942fc https://doi.org/10.1016/j.jaccas.2025.106415

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Aortic Valve Stenosis and Insufficiency Combined With Aortic Coarctation

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Aortic Valve Stenosis and Insufficiency Combined With Aortic Coarctation

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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