Management in a 5-year-old diagnosed with severe coarctation of the aorta, aortic arch hypoplasia, doubly committed sub-arterial ventricular septal defect, large patent ductus arteriosus, and severe pulmonary hypertension: Case report

Abstract

Introduction: Coarctation of the aorta is a congenital heart disease often associated with other cardiac abnormalities, including aortic arch hypoplasia and ventricular septal defect. These multiple anomalies also contribute to pulmonary hypertension, which can significantly increase mortality and morbidity. Management strategies for aortic coarctation and other heart defects vary based on individual cases.

Case description: We present the case of a 5-year-old diagnosed with coarctation of the aorta, aortic arch hypoplasia, doubly committed sub-arterial ventricular septal defect, large patent ductus arteriosus, and severe pulmonary hypertension, who underwent staged surgery beginning in 2023. The initial surgery successfully addressed aortic coarctation and aortic arch hypoplasia, along with pulmonary artery banding. A second surgery, intended for ventricular septal defect closure and pulmonary artery de-banding, is scheduled with a one-year interval following the initial procedure. Close monitoring of the patient's condition, particularly pulmonary pressure, will be maintained throughout this period. The patient has been under antihypertensive medication since before the first surgery.

Conclusion: The primary goal of intervention is to manage severe pulmonary hypertension and improve circulatory function. Follow-up evaluations in the patient have revealed favorable outcomes, evidenced by the patient's improved hemodynamic status and echocardiography results.