Critical aortic coarctation in very low weight premature: primary angioplasty with coronary stent as bridging therapy. How would I approach it?

Abstract

The authors present the case of a preterm baby of 27 + 5 weeks of gestational age and 990 grams of body weight at birth. After an IV dose of ibuprofen to treat a ductus arteriosus with hemodynamic repercussion, a serious femoral pulse wave attenuation occurred with a systolic gradient of 60 mmHg in the aortic isthmus as seen on the Doppler ultrasound followed by significant diastolic prolongation of forward flow, and distal transverse arch hypoplasia. The diagnosis was severe aortic coarctation (AoC). Treatment was initiated with prostaglandins. Still, the arm-leg blood pressure gradient increased until the patient’s condition got worse on his 13th day of life with a body weight of 1200 grams. Also, the patient’s hemodynamic status got worse with severe left ventricular dysfunction and dilatation refractory to high-frequency ventilation and inotropic support with dobutamine.