Palliative stenting in a newborn with critical coarctation of the aorta

Abstract

Newborns with critical coarctation of the aorta with a closed arterial duct often require surgical repair. Primary repair is associated with a high risk of unfavorable outcomes owing to severe systemic outflow obstruction and multiple organ failure. We present the case of a premature male newborn (weight = 1.9 kg) with critical coarctation of the aorta and multiple organ dysfunction syndrome with a closed arterial duct who successfully underwent isthmus stenting as a palliative step before surgical repair. The indication for primary stent implantation was decompensated metabolic acidosis. For stenting, the retroperitoneal approach was selected, and elective surgical cut-down of the right iliac artery was performed. Standard coronary stents (diameter = 4 mm; length = 13 mm) were delivered via a 4F sheath. The right iliac artery was repaired after sheath removal. The procedure was successful, and there were no procedural complications. Four days after stent implantation, the patient was stable, and he then underwent surgery. The coronary stent was extracted, the aortic isthmus was divided, and an extended anastomosis was created. The surgery was performed without complications. On the fourth day, the newborn was transferred from the intensive care unit to the ward, and on the fifteenth day, he was discharged from the hospital in good condition. Hence, palliative stenting is beneficial in newborns with critical aortic coarctation in the decompensated state because it stabilizes and prepares them for subsequent radical surgery, thereby reducing the risk of severe complications and mortality.