Successful Transcatheter Angioplasty Preceding Corrective Repair in an Extremely Low-Birth-Weight Infant with Coarctation of the Aorta

Abstract

For infants with coarctation of the aorta (COA), either transcatheter balloon angioplasty (BA) or surgical repair is used. COA recurs frequently in low-birth-weight infants who have had either BA or surgical repair. We present a case of a baby girl born at 35 weeks gestational age and weighing 1,374 g who underwent successful surgical repair of COA following palliative BA. A systemic blood pressure gradient of 64 mmHg between the upper and lower limbs was observed at the age of 6 days, confirming the diagnosis of COA. At the age of 25 days, we conducted BA for COA with a minimum diameter of 1.3 mm. Following the placement of a 3-French sheath in the femoral artery, we performed a predilatation with a coronary angioplasty balloon (NC TREK^®2 mm) and a second dilatation with a valvuloplasty balloon (TMP-PED^®4 mm). The systemic blood pressure difference between the upper and lower limbs was reduced to 9 mmHg after successful dilation. As a recurrence of COA developed along with body weight gain, coarctation resection and extended end-to-end anastomosis were performed at the age of 108 days and weight of 3,050 g. At the age of 7 months, there was no recurrence of COA. We believe that delayed surgical repair after palliative BA may be possible in low-birth-weight infants with COA to avoid recurrence of COA.