Iliac Artery Dissection After Stenting Preductal Coarctation of the Aorta Associated With Severe Pulmonary Artery Hypertension

Preductal coarctation of the aorta associated with patent ductus arteriosus (PDA) during adulthood is very rare. We herein describe a 19-year-old female patient with this anomaly who presented with ascites and dyspnea (functional class III). A complete evaluation showed a large PDA, a large ventricular septal defect, severe coarctation of the aorta, severe pulmonary arterial hypertension, and severe biventricular dysfunction. Cardiac catheterization revealed evidence of a left-to-right shunt via the ventricular septal defect and vasoreactivity in the pulmonary artery. Staged interventions were, therefore, planned. The PDA was closed, and the coarctation was relieved with a Covered CP Stent. On the first postprocedural day, the patient complained of leg pain. Physical examination showed that she was pulseless. Once again, she was transferred to the catheterization laboratory, where dissection and thrombosis were detected in the iliac and femoral arteries. Balloon angioplasty and stenting of the iliac artery to the femoral artery were performed successfully. During the follow-up, the lower limb pulses were normal, biventricular function was improved, and pulmonary artery pressure was decreased significantly. (Iranian Heart Journal 2021; 22(2): 130-135)