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Description

Aortic coarctation (CoA) is a focal constriction of the arterial wall usually located around the aortic isthmus and is the fifth most common congenital heart defect (CHD).  Traditionally most patients undergo gold standard open repair during childhood but occasionally these lesions are missed or reoccur after repair with patients presenting in adulthood with symptoms of hypertension, claudication, extremity pressure gradients, left ventricular hypertrophy and congestive heart failure. Research is ongoing with regards to the best approach to these patients on whether percutaneous endovascular repair may potentially have a role in treatment.  This case represents an adult patient with symptomatic aortic coarctation who was treated percutaneously with an endovascular stent graft as opposed to open repair or balloon expandible stent.

68-year-old male with a remote history of open atrial septal defect repair in childhood who was being evaluated by cardiology for hypertension was noted on echocardiogram to have mild LVH and mild PAH (RVSP 35 mmHg) and a 37-mmHg pressure gradient in the descending thoracic aorta. Computed tomography angiography of chest then illustrated a descending thoracic aortic coarctation measuring 1.2 cm in diameter. Initially this was monitored but over the course of several years the patient developed worsening blood pressure control, developed fatigue and claudication of his lower extremities. Repeat echocardiogram showed grade 1 diastolic dysfunction, severe concentric left ventricular hypertrophy and a coarctation mean gradient of 27- mmHg. Ankle brachial index was also performed showing a value of 0.77.

This case illustrates the changing paradigm in aortic coarctation treatment and how an endovascular approach with TEVAR in select patients who are optimal candidates over open surgical reconstruction is possible. The significant risk reduction associated with endovascular repair while also providing tangible clinical results shows the benefits of this approach in treatment. Greater collaborative efforts in this specific patient population at our institution will continue to provide more insight on which patients will benefit from TEVAR repair.

Publication Date

5-8-2026

Disciplines

Cardiology

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2003

Coarctation of the Aorta Treated with TEVAR

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