Coarctation Stenting When Origin of Aberrant Right Subclavian Artery Is Before Stenotic Segment.

BACKGROUND

Occasionally, coarctation of the aorta (CoA) may go unnoticed and present in adulthood with left ventricular dysfunction. Variations in anatomy of the neck vessels can add to the complexity in management.

CASE SUMMARY: Our patient underwent surgical repair of a double-outlet right ventricle during which CoA was overlooked. She presented later with peripartum "cardiomyopathy" when CoA was diagnosed on 2-dimensional echocardiography. During transcatheter intervention, an aberrant right subclavian artery (ARSA) was seen arising before CoA opposite the origin of the left subclavian artery. The CoA was successfully treated with a bare metal stent without compromising the flow through either of the subclavian arteries.

DISCUSSION: ARSA is present in 1% of the population and usually arises distal to CoA, unlike in this case, where ARSA was proximal to the coarct.

TAKE-HOME MESSAGE: Diligent analysis of the origin of neck vessels is mandatory to plan and prevent them from jailing during stenting.