Hybrydowa, przezskórna terapia złożonej koarktacji aorty w cieniu pandemii SARS-CoV-2

Introduction. Coarctation of the aorta (CoA) is a congenital heart defect defined as a narrowing in the region of aortic isthmus, clinically presenting with peripheral perfusion disturbances in physical examination. Newborns are majority of the affected and surgery is the management of choice in these patients. However, some may not present with CoA symptoms until later childhood, with mostly percutaneous interventions as a favorable method of treatment. Aneurysms, heart failure and stroke are the main complications of untreated CoA, which explains low survival rate of undiagnosed patients. Case report. A 5-year-old female patient in good general condition presented with a heart murmur during a prophylactic pediatric control. The patient was referred to pediatric cardiologist, but unfortunately due to ongoing coronary disease 2019 pandemic only telemedical consultation was available, precluding physical examination. Finally, the patient was referred to hybrid pediatric cardiac surgery department as an urgent consultation of the dubious anamnesis. The echocardiographic study revealed continuous, non-pulsatile flow in the abdominal aorta with a narrowed descending aorta behind the left atrium, and the CoA was a suspected diagnosis. The angio-computed tomography (CT) confirmed tubular (55 mm long) narrowed section of thoracic aorta (up to 2.5 mm diameter) with concomitant collateral circulation. Due to the anatomy of the aortic lesion the patient was referred for transcatheter stent graft (Bentley BeGraft © 9 mm/57 mm) implantation with ECC-backup. An initial dilatation to 9 mm except the region around 6mm long narrowed to 5.2 mm was performed. After 2 months, the stent graft was dilated again, and echocardiography confirmed uniformed aortic lumen (9 mm). The postprocedural course was uncomplicated; the patient was discharged home and referred for further follow-up. Conclusions. The CoA rarely occupies a non-typical region and therfore may be diagnostically challenging without a profound phisical examination, particularly in later childhood and pandemic settings, and may result in serious complications, if untreated.