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Case Reports
. 2022 Feb 16;4(4):226-229.
doi: 10.1016/j.jaccas.2022.01.002.

Hybrid Transcarotid Exclusion of Postoperative Ascending Aortic Dissection in an Infant

Sara Sadat-Hossieny  1 , Salima Bhimani  1 , Alistair Phillips  2 , Munir Ahmad  2 , Edgard Bendaly  1 , Thomas E Fagan  1
Affiliations
Case Reports

Hybrid Transcarotid Exclusion of Postoperative Ascending Aortic Dissection in an Infant

Sara Sadat-Hossieny et al. JACC Case Rep. .

Abstract

Aortic dissection is very rare in pediatric patients, and associated risk factors include congenital heart disease, previous cardiac surgery, and vasculopathies. Acute postoperative aortic dissection in pediatric patients can be life-threatening. We performed a novel hybrid transcarotid covered stent exclusion of a postoperative ascending aortic dissection in an infant. (Level of Difficulty: Advanced.).

Keywords: AA, ascending aorta; CAA, coronary artery aneurysm; CHD, congenital heart disease; ECMO, extracorporeal membrane oxygenation; LV, left ventricular; LVEDp, left ventricular end-diastolic pressure; POD, postoperative day; RCA, right carotid artery; aortic dissection; congenital heart disease; covered stent; ePTFE, expanded polytetrafluoroethylene; hybrid; iCAST stent; infant.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Aortic Root Angiogram Aortic root angiogram demonstrating a large, obstructive dissection (bracket) extending from the midascending aorta to the base of the innominate artery. The coronary arteries are aneurysmal (arrows) but stable in size without obstruction. CRAN = cranial; LAO = left anterior oblique.
Figure 2
Figure 2
Aortogram After RCA Cutdown Angiogram through the right carotid artery (RCA) sheath with the tip in the aortic root showing severe aortic obstruction from the dissection. The proximal ascending aorta (arrow 1) is 8.8 mm, the minimal diameter (arrow 2) is 3.6 mm, the distal ascending aorta (arrow 3) is 9.9 mm, and the length of dissection (bracket) is 18.8 mm. Abbreviations as in Figure 1.
Figure 3
Figure 3
Stent Preparation (A) The covered stent after partial expansion with the premounted balloon. (B) The covered stent positioned on the 10-mm balloon used for delivery. (C) The final prepared stent after manual crimping to the minimal profile.
Figure 4
Figure 4
Covered Stent Implantation (A) Covered stent positioned across the dissection angiographically (arrowhead, entrance to dissection). (B) Balloon expansion to implant the stent. (C) Final aortic root angiogram demonstrating patency of the aortic lumen and exclusion of the dissection. Minimal diameter (arrow) is 8.0 mm. Abbreviations as in Figure 1.
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