Specialists at London’s Great Ormond Street Hospital (GOSH) successfully used a staged endovascular technique to stabilise a child suffering from middle aortic syndrome (MAS) and severe heart failure.
The approach has enabled the necessary reconstructive surgery that had initially been considered too high-risk.
The strategy centred on serial angioplasty procedures to improve blood pressure control and reduce the strain on the heart, allowing cardiac function to recover sufficiently.
Seven-year-old Elliot Atkins eventually underwent complex vascular reconstruction and kidney autotransplantation.
Elliot was just 11 months old when he developed heart failure following a respiratory infection. After transfer to GOSH, he was diagnosed with MAS.
The severity of his heart failure meant that definitive surgery was not initially an option. Instead, specialists developed a staged treatment plan with Elliot undergoing six angioplasty procedures, which improved blood pressure control and gradually strengthened his heart.
Although his condition later deteriorated, with worsening hypertension requiring removal of his right kidney, the earlier interventions had achieved their aim.
By improving his cardiac function, they created a window in which surgery became possible.
Last year, as his remaining kidney function declined, Elliot underwent a combined aortic bypass and kidney autotransplant.
The operation restored blood flow around the narrowed section of his aorta using a synthetic graft while relocating his kidney to improve its blood supply and help control his blood pressure.
The graft was designed with additional length to accommodate future growth, reducing the likelihood of further surgery.
One year on, Elliot has normal heart and kidney function, his blood pressure is well controlled, and his medication burden has reduced by around two-thirds. He is not expected to require any further vascular surgery.
Since performing Elliot’s first angioplasty in 2020, the GOSH team has adopted the approach for other children with MAS presenting in heart failure.
What began as an innovative treatment strategy for a single patient is now expanding the options available for children who might previously have been considered for palliative care alone.
Dr Jelena Stojanovic, lead for the kidney transplant and renovascular service, said: ‘Seeing Elliot doing so well is incredibly rewarding. At GOSH, our teams work together to care for children with the rarest and most complex conditions. This means we often use our collective expertise to push the boundaries of what is possible and treat conditions that are otherwise untreatable. Elliot’s recovery reflects the skill, determination and commitment of everyone involved to provide the best possible care.’
