A 13 year-old boy was diagnosed with simple aortic coarctation and a bicuspid aortic valve. Ascending aorta was mildly dilated while aortic arch was smaller, but not hypoplastic. A decision to treat him was made depending on the clinical finding of systemic hypertension in his young age and a baseline trans-stenotic echographic gradient of 48 mmHg. Direct stenting with a covered Cheetham-Platinum balloon-expandable stent was performed with no complications. Despite immediate good angiographic and hemodynamic result with marked decrease of invasively measured gradient, consecutive echographic follow-up demonstrated progressive increase of the gradient in the first 9 months after the index procedure. This resulted in repeated aortic PTA with a larger balloon inside the previously implanted stent-graft. Optimal angiographic result was obtained, the patient remained symptom-free and no antihypertensive therapy was necessary thereafter.Modern treatment of simple aortic coarctation can be done in the cath-lab in appropriately selected cases. Stent implantation should be considered in all cases to avoid dissection and early elastic recoil. Long term follow-up may evidentiate the need for repeated PTA procedures in some cases.
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