From Crafoord’s End-to-End Anastomosis Approach to Percutaneous Interventions: Coarctation of the Aorta Management Strategies and Reinterventions

Figures

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  Figure 1. Management algorithm based on the age of the patient. Native CoA: native coarctation of the aorta; Re-CoA: recoarctation of the aorta.

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  Figure 2. Infant coarctation case. (A) The CT scan highlights the recoarctation, precisely measuring it at 2 mm. (B) Angiography further confirms the recoarctation, showing a trans-coarctation gradient of 40 mmHg. (C) Post-treatment angiography after a 5.5 mm non-compliant Boston balloon dilatation, showing reduced gradient to 16 mmHg.

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  Figure 3. Adult-onset native coarctation. (A) The angioscanner reveals a 4 mm isthmic coarctation. (B) Confirmation through profile aortic angiography demonstrates a trans-coarctation gradient of 34 mmHg. (C) The patient was successfully treated with a 43 mm XXL Andrastent bare stent mounted on a 14 × 40 mm BiB Balloon, yielding ideal results. (D) The stent was initially placed and later redilated with a larger balloon to optimize its positioning in the aorta. The angiography clearly shows the bare stent properly as opposed to the aortic wall, with no evidence of aortic wall damage.

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  Figure 4. Pediatric isthmic recoarctation case. (A) Notch on the dilatation balloon. This notch reflects a trans-recoarctation gradient of 20 mmHg. (B) Close-up view of the notch on the dilatation balloon, highlighting the details of the recoarctation. (C) The notch was effectively and completely lifted by a 7 × 20 mm Tyshak balloon. (D) Subsequent angiography reveals good angiographic and hemodynamic results, with a residual gradient of just 9 mmHg.

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  Figure 5. Infant recoarctation after initial repair (Waldhausen technique). (A) The recoarctation is measured at 3.7 mm, in the context of a horizontal aorta measuring 5.3 mm and a descending aorta of 7.1 mm. The trans-recoarctation gradient is 30 mmHg. Note the absence of a left subcardiac artery. (B) Treatment involved a 6 × 20 mm Tyshak balloon dilatation. (C) Subsequent angiography shows an isthmus diameter of 5.5 mm with no residual gradient, indicating a successful outcome.

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  Figure 6. Toddler’s recoarctation after initial repair. (A) Isthmus before dilatation, measuring 5.4 mm within a descending aorta and aortic arch of 9.4 mm. (B) Dilatation was achieved using an 8 × 20 mm Tyshak balloon. (C) Post-dilatation control angiography indicates a successful outcome with an isthmus diameter of 7 mm.