Coarctation of Aorta in a 21-year-old Female: A Case Report

摘要

Background: The aortic coarctation is a congenital malformation of the aorta, characterised by the narrowing of the aorta. It represents for 5 – 10% of congenital heart diseases and it shows a male predominance. Its diagnosis is usually posed and treatment done early in life. Objective: In this case report, we present a late diagnosis of isthmic aortic coarctation in a 21-year-old female. Clinical and para-clinical presentation: The patient was relatively asymptomatic until she was fortuitously diagnosed with hypertension. Physical examination showed blood pressures of 182/89 mmHg (left arm) and of 194/89mmHg (right arm), a bradycardia of 52 beats/minute. On cardiovascular physical assessment was recorded a systolic murmur of intensity 3/6, posterior over the thoracic spine and subclavicular space and a decrease in femoral pulse. Biological exams such as creatininemia and kalemia were normal. The transthoracic echocardiogram showed a stenosis at the isthmic part of the descending aorta, with an increased peak velocity of 3.6 m/s (max gradient = 50 mmHg) and no associated patent ductus arteriosus. Thoracic computerised tomographic (CT) angiography showed an aortic isthmus coarctation with a rounded arch. The CT angiography also recorded duplicated superior vena cava, dilatation of collateral partway below the coarctation to hypertrophied intercostal, internal mammary artery dilatation and Cardiomegaly with left ventricular dilatation. The electrocardiogram recorded a sinus bradycardia at 47 bpm. The chest X-ray noted an enlargement of the cardiac figure, without notching of the ribs. She was addressed to the Cardiac Center of Saint Elisabeth Catholic Hospital of Shison for a surgical management. Meanwhile, she was placed on combined therapy (Atenolol 50mg and Nifedipine 20mg daily) and a good clinical condition was achieved. Conclusion: A fortuitously discovered case of late aortic coarctation, diagnosed in a 21 year female during the evaluation of an asymptomatic hypertension. Echocardiographic assessment permitted to pose de diagnosis. Prior to surgical management, Blood pressure controlled was achieved on pharmacological treatment. Due to financial constraint her interventional therapy is pending. The particular aspect in this case was the association of a duplicated superior vena cava.