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Re-coarctation Stenting — EECC MCQ

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ModerateCongenital Heart Disease (Adult)Re-coarctation StentingEECC

A 25-year-old man with surgically repaired aortic coarctation at age 2 presents with headaches and upper limb hypertension (BP arms 165/100, legs 130/80). MRI shows re-coarctation with a peak gradient of 30 mmHg across the repair site. What intervention is preferred?

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Correct answer: B — Percutaneous balloon angioplasty with stent implantation at the re-coarctation site

For re-coarctation after previous surgical repair, percutaneous balloon angioplasty with stent implantation is the preferred intervention (Class I). It avoids the higher morbidity of redo surgery (adhesions, recurrent laryngeal nerve injury, spinal cord ischaemia risk). Indications for intervention per ESC ACHD Guidelines: (1) non-invasive peak-to-peak gradient >20 mmHg; (2) gradient <20 mmHg with significant collateral flow, hypertension, or LV dysfunction. This patient has a gradient of 30 mmHg with hypertension, meeting intervention criteria. Bare-metal or covered stents are used depending on anatomy. Long-term surveillance is needed for in-stent restenosis and aortic wall complications.

Reference: ESC (2020): Guidelines for the Management of Adult Congenital Heart Disease