Coarctoplasty in a case of ventricular septal defect, patent ductus arteriosus with coarctation of aorta and Eisenmenger's syndrome: Is it safe?

Endovascular Coarctoplasty (CoAP) with stenting is the treatment of choice in Coarctation of Aorta (CoA). Literature on the harms or benefits of CoAP in Eisenmenger's syndrome (ES) is scarce. There is the hypothetical possibility of an increase in right-to-left intracardiac shunting once the coarctation is relieved. We report a 17-year-old male adolescent who presented with secondary hypertension, cyanosis, and lower limb claudication. He was diagnosed as a case of ventricular septal defect (VSD), patent ductus arteriosus (PDA), and CoA with associated ES. He underwent successful balloon CoAP with no clinical or invasive hemodynamic deterioration. At one-year follow-up, there was no clinical or echocardiographic evidence of complications from ES or restenosis. This case highlights that CoA with ES can be safely managed by CoAP with good long-term results. The proposed pathophysiology for the uneventful procedure is an extension of our understanding of the 'shunt dynamics' in cyanotic spells in patients with congenital cyanotic heart diseases.