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Published on: February 4, 2021
The Calcified Barrier: A Rare Cause of a Distal Aortic Arch Stenosis
J Gottsberger1, F Huber1, P Szalkiewicz1
1Department for Cardiac, Vascular and Thoracic Surgery, Johannes Kepler University Linz, Kepler University Hospital Linz, Linz, Austria.
Background:
Calcification of the aortic arch is common, but an intraluminal calcified plaque causing functional stenosis is rare. At the distal arch, it mimics aortic coarctation, with refractory upper-body hypertension and left ventricular pressure overload.
Case Summary:
A 61-year-old man presented with refractory hypertension despite 4 agents and recurrent hypertensive cardiac decompensation with an upper-to-lower-limb blood pressure gradient. Computed tomography angiography showed a high-grade calcified stenosis of the distal arch (peak gradient 70 mm Hg; left ventricular ejection fraction 30%). The lesion was resected en bloc and the arch reconstructed with a frozen elephant trunk prosthesis under selective cerebral perfusion. Recovery was uneventful; the gradient resolved and left ventricular ejection fraction improved to 45% at 6 months.
Discussion:
Coral reef obstruction of the arch is rare, lacks management guidelines, and is easily mistaken for congenital coarctation or Takayasu arteritis.
Take-Home Message:
When rigid calcification precludes endovascular therapy, en bloc resection with frozen elephant trunk reconstruction offers a safe and durable repair.
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