1. Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina. Percutaneous Treatment of Severe Aortic Coarctation with PTFE-covered Stent ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION Granja Miguel ‡., Gabay Jose*., Trentacoste Luis ‡., Rojas Matas Carlos*., Berrocal Daniel*., Grinfeld Liliana** Servicio de Hemodinamia y Cardiologia Intervencionista Hospital Italiano. Buenos Aires. ARGENTINA. * Interventional Cardiology ‡ Interventional Cardiology in Congenital Heart disease ** Director

2. Patient: G.A. Gender: Male Age: 25 ys History: Patient was referred to the hospital with severe aortic regurgitation diagnosis. At admission, the patient showed severe aortic regurgitation and aortic coarctation was suspected for absent femoral pulses and systemic hypertension (180/60 mmHg). Granja Miguel et col. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

3. At clinical examination, the patient showed absent femoral pulses and 180/60 mmHg arterial pressure at right arm. Echo Doppler showed moderate to severe aortic regurgitation. Severe coarctation was observed at MRI with almost complete narrowing of thoracic Aorta in a short segment and significant collateral circulation. Endovascular treatment of coarctation by angioplasty with balloon-expandable PTFE- covered stent was proposed. Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

4. Catheterization was performed under sedation and IV analgesia by percutaneous right femoral approach Angiography showed severe aortic coarctation with 100 mmHg of systolic gradient Aortic Isthmus was hypoplasic and a thin patent ductus arteriosus was seen in coarctation front view Granja Miguel et col. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

5. Coarctation site was crossed with a floppy 0,035” guide wire and then exchanged for Amplatz™ Extra Stiff guide wire. Over this wire, a Mullins™ 13Fr sheath was introduced without predilation A 8 zigs by 39mm, PTFE- covered CP Stent™ (Numed) was mounted on 45mm long BIB™ balloon (Numed), with a 14mm external balloon and 7mm internal balloon The whole system was introduced over the wire, through the Mullins sheath and positioned under fluoroscopic control Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

6. Internal and external balloons were insufflated until nearly complete expansion was achieved Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

7. Final results showed normal flow through the stent graft in angiography and no residual gradient at pressure measurements Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

8. Patient remained 24hrs at ICU with uneventful recovery Blood pressure measurements ranged within normal values MRI showed normal flow through the stent and no evidence of dissection or hematoma Aortic regurgitation by Echo Doppler remained unchanged Femoral pulses were normal At 48hrs the patient was discharged with no medication At 3-month follow-up, the patient remained normotensive on no medication and the aortic valve replacement is being planned Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina. ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION

9. Conclusion Endovascular treatment of severe aortic coarctation by angioplasty with balloon- expandable PTFE-covered CP Stent and Balloon-In-Balloon was a feasible and safe technique in patients with these conditions Granja Miguel et al. Hospital Italiano de Buenos Aires. Argentina ENDOVASCULAR TREATMENT OF SEVERE AORTIC COARCTATION