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Aortic coarctation: guidelines mismatch across the ocean
Martino Pepe, Fortunato Iacovelli1, Filippo Masi
1Section of Cardiovascular Diseases, Emergency and Transplantations Department, "Aldo Moro" University, Piazza Giulio Cesare 11, 70124 Bari, Italy. fortunato.iacovelli@teletu.it.
Insights
Pseudocoarctation, a rare aortic anomaly, involves elongation and kinking without severe obstruction. Accurate diagnosis requires integrating functional and anatomical imaging data for complex cases.
Area of Science:
- Cardiology
- Medical Imaging
- Congenital Heart Disease
Background:
- Pseudocoarctation of the aorta is a rare congenital anomaly.
- It is characterized by aortic elongation and kinking without significant obstruction.
- Elderly patients with comorbidities like congestive heart failure and aortic regurgitation may present with atypical symptoms.
Observation:
- A case report of an elderly patient with progressive exertional dyspnea is presented.
- The patient had a history of congestive heart failure and aortic regurgitation.
- Multimodal imaging revealed aortic coarctation with a significant trans-stenosis gradient but mild luminal narrowing.
Findings:
- The patient's condition was borderline, not meeting criteria for surgical repair per ESC guidelines, though AHA guidelines differed.
- The diagnosis of pseudocoarctation was considered based on the overall clinical and imaging picture.
- This case highlights the diagnostic challenges in differentiating true coarctation from pseudocoarctation.
Implications:
- Accurate diagnosis of aortic anomalies is crucial for appropriate patient management.
- Integrating functional and anatomical data from multimodal imaging is essential for reliable diagnosis.
- This case underscores the importance of individualized assessment in borderline cases of aortic coarctation/pseudocoarctation.
Abstract:
Pseudocoarctation is a rare congenital anomaly characterized by aorta elongation and kinking, without significant obstruction. We report the case of an elderly patient with history of congestive heart failure (CHF) and aortic regurgitation (AR) who was referred for progressive exertional dyspnoea. After multimodal imaging evaluation, aortic coarctation with significant trans-stenosis gradient but mild luminal narrowing was diagnosed; this borderline patient was not addressed to repair, according to ESC guidelines and in spite of AHA ones. He rather met the criteria for pseudocoarctation diagnosis. An integration of functional and anatomical data is essential for a reliable diagnostic process in similar cases.
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