Counter-current aortography for aortic coarctation.

We describe a 1-month-old infant who developed a cardiogenic shock. Echocardiography suspected an aortic coarctation. Left brachial artery counter-current aortography gave safe and adequate imaging of the aortic coarctation. We see many advantages to this approach: (1) most complications associated with classical cardiac catheterization are significantly reduced, (2) adequate imaging of coarctation, anatomy of the aortic arch and eventually collateral circulation is obtained, (3) the volume of contrast is reduced, (3) increased risk of femoral artery injury is avoided, (4) the procedure lasts only a few minutes, and (5) no sedation is needed. We conclude that left brachial artery counter-current aortography is a safe, quick and relatively non-invasive procedure which can be used in infants in whom clinical, cross-sectional, and Doppler echocardiographic findings are suggestive but not conclusive of anomalies of the aortic arch, especially when magnetic resonance imaging is not available or cannot be performed safely because the infant is critically ill.