TEVAR in patient with covered rupture of a thoracic aortic aneurysm following patch plastic of an aortic caorctation

Abstract

The coarctation of the aorta is one of the most frequent congenital diseases of the cardiovascular system. It constitutes between 5% and 8% of all congenital heart malformations. The frequency of the isolated forms is 3 in every 10 000 live births [1]. The exact mechanism of this disease is still an enigma. However, most hypothesis suggests an abnormal blood flow in the area of ductus arteriosus or abnormal angle between the ductus and the aorta, which leads to reduced blood flow through the shunt and potentiate the formation of the stenosis. Another theory postulates abnormal extension of ductal tissue into the aorta (ectopic ductal tissue), which leads to developing of an aortic obstruction [2].

   The treatment of this condition could be surgical or interventional. Formation of aneurysm in the corrected zone of the aorta is the most prevalent long-term complication of the surgical treatment. The risk of aneurysm rupture increases exponentially with the aneurysm dimensions. The rupture of the thoracic aortic aneurysm is associated with very high mortality and very few patients are usually admitted alive to the emergency care units [3]. In some cases, the rupture can be limited by the surrounding tissues, which reduce the exsanguination – so called “covered rupture”. The diminished blood flow in the ruptured zone allows formation of a parietal thrombosis [4].

In this clinical case we present a sixty-four-year-old man with covered rupture of the descending aorta. The patient is with known Dacron-patch surgical treatment due to a coarctation of the aorta at young age. A successful endovascular treatment (TEVAR) was performed with implantation of an endoprosthesis.