AP

28-year-old male with Incomplete Shone complex consisting of severe Juxtaductal coarctation of aorta and Supra mitral ring causing moderate to severe mitral stenosis. He also had additional mid muscular ventricular septal defects and patent ductus arteriosus with moderate pulmonary artery hypertension and atrial fibrillation. 

Pre-operative echo showed incomplete Shone complex consisting of supramitral ring & Aortic coarctation with muscular VSD & PDA

Procedure done: Hybrid stent placement for coarctation of aorta with 14 x 40 mm covered mounted CP stent followed by surgical resection of the supramitral ring, closure of VSD and left atrial appendage closure.Percutaneous Intervention: Through right femoral artery access, coarctation could not be crossed. Hence, using right brachial artery access, 5F pigtail catheter was placed in aortic arch & angiogram done showed Coarctation segment. Antegrade crossing of coarctation was done with 0.035�� Terumo wire and snared through femoral artery access. 5F MPA catheter was inserted and crossed the coarctation point. 14 F 63mm Cook sheath was used and via an extra stiff wire, the Coarctation segment was stented with 14 x 40 mm covered mouthed CP stent. Post dilation was done with 18 x 40 mm Tyshak balloon. Check angiogram shows good result and no dissection.Following the percutaneous coarctoplasty, he was shifted for surgery and successful resection of the supramitral ring with closure of VSD and left atrial appendage was done. The post-operative period was uneventful. Post-operative echocardiogram showed no significant gradient in descending aorta, no residual shunt across VSD and PDA and adequate left ventricle function.

Through right femoral artery access, coarctation could not be crossed. Hence, using right brachial artery access, 5F pigtail catheter was placed in aortic arch & angiogram done showed Coarctation segment. Antegrade crossing of coarctation was done with 0.035�� Terumo wire and snared through femoral artery access. 5F MPA catheter was inserted and crossed the coarctation point. 14 F 63mm Cook sheath was used and via an extra stiff wire, the Coarctation segment was stented with 14 x 40 mm covered mouthed CP stent. Post dilation was done with 18 x 40 mm Tyshak balloon. Check angiogram shows good result and no dissection.Following the percutaneous coarctoplasty, he was shifted for surgery and successful resection of the supramitral ring with closure of VSD and left atrial appendage was done. The post-operative period was uneventful. Post-operative echocardiogram showed no significant gradient in descending aorta, no residual shunt across VSD and PDA and adequate left ventricle function.

We have performed a single stage hybrid repair of aortic coarctation stenting followed by surgical correction of mitral valve anomaly and ventricular septal defects. The simultaneous approach enabled us to undertake this complex surgical case with reduced peri operative risk. Hybrid procedures reduce duration and complexity of surgery, shortens the cardiopulmonary bypass time, avoids requirement for secondary surgery, reduces post-operative complications and hospitalization time. Hybrid repair can be considered as a successful and safe alternative for treating complex congenital heart disease.