Surgical revascularisation in an adult with coarctation of the aorta
Jocilin Joseph1, Sindhu Swarna1, Suraj Pai2
1Department of Cardiothoracic and Vascular Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India.
Insights
Coarctation of the aorta (CoA) is a common heart defect. Adults with undiagnosed CoA may experience severe symptoms, necessitating early screening for hypertension and ischemic conditions.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coarctation of the aorta (CoA) is a prevalent congenital cardiac anomaly, comprising 4%-6% of all congenital heart defects.
- Adults with untreated CoA often develop severe complications, including hypertension, diminished peripheral pulses, and potential heart failure.
Observation:
- A young adult male presented with severe lower limb and abdominal pain, alongside long-standing, treatment-resistant hypertension.
- Clinical examination revealed significant discrepancies in upper and lower limb blood pressures, weak peripheral pulses, and radiofemoral delay.
- Diagnostic angiography confirmed adult coarctation of the aorta with complete occlusion of the proximal aortic segment.
Findings:
- The patient successfully underwent a left axillary artery to descending thoracic aorta bypass graft.
- Post-operative recovery was uneventful, and the patient was initiated on lifelong antihypertensive medication.
Implications:
- Untreated coarctation of the aorta in adulthood leads to serious, potentially life-threatening complications.
- Individuals presenting with unexplained hypertension and ischemic symptoms should be evaluated for coarctation of the aorta.
Abstract:
One of the most common congenital cardiac anomalies is coarctation of the aorta (CoA) It accounts for 4%-6% of all congenital heart defects. A CoA case surviving into adulthood may result in hypertension, weak femoral pulse, limb and bowel ischaemia and heart failure. A man in his early 20s presented with severe lower limb and abdominal pain with long-standing hypertension, refractory to antihypertensives. Difference in upper and lower limb blood pressures, weak peripheral pulses and radiofemoral delay were noted. Angiogram showed adult CoA with total occlusion of the proximal aortic segment. The patient underwent left axillary artery to descending thoracic aorta bypass grafting, had a normal recovery and was put on life-long antihypertensives. An untreated case of CoA surviving into adulthood will result in complications. Any individual with unknown aetiology of hypertension and ischaemic symptoms must be screened for CoA.
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