• Xiao-Bo Pu, Shi-Jian Chen, Mao Chen, and Yuan Feng.
• Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
• Medicine (Baltimore). 2017 Dec 1; 96 (48): e8618.

RationaleCoarctation of aorta in adulthood is usually complicated by other cardiovascular anomalies, posing great technical challenge for intervention.Patient ConcernsHere, we report an extremely rare case of aortic arch coarctation combined with a poststenotic biloculated calcified aneurysm and hypoplastic left subclavian artery.InterventionsFirst, an extra-anatomic bypass was established, along with narrowing of aorta just proximal and distal to the aneurysm. While the bypass graft significantly relieved trans-coarctation gradient, the latter procedure decreased intra-aneurysm pressure and created landing zones for aneurysm occlusion. Six months later, 2 muscular ventricular septal defect occluders were deployed at the proximal and distal orifice of the aneurysm.OutcomesFollow-up computed tomography angiography confirmed the absence of contrast leakage into aneurysm.ConclusionsA 2-stage hybrid approach described here appears to be feasible, safe, and associated with favorable clinical outcomes in the treatment of complicated aortic coarctation and poststenotic aneurysm.

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