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[Subisthmic aortic coarctation. Apropos a rare case of arterial hypertension]
J Nóbrega1, R Rosa M, R M Santos
1Serviço de Medicina I, Hospital de Santa Maria, Lisboa.
Insights
This case report details a rare instance of high blood pressure caused by subisthmic aortic coarctation. Surgical arterial revascularization successfully treated the condition, restoring normal blood pressure.
Area of Science:
- Cardiology
- Vascular Surgery
- Pediatric Cardiology
Background:
- Subisthmic aortic coarctation is a rare congenital condition causing secondary hypertension.
- Early diagnosis and surgical intervention are crucial for managing aortic coarctation.
Observation:
- An abdominal systolic-diastolic bruit, hypertension, and weak femoral pulses suggested the diagnosis.
- Diagnostic imaging included Doppler ultrasonography and nuclear magnetic resonance, with angiography proving most informative.
Findings:
- Surgical exploration revealed a hypoplastic descending thoracic aorta.
- Histological examination confirmed a congenital, non-acquired aortic wall pathology.
- Successful surgical management resulted in the patient being asymptomatic with normal blood pressure post-operation.
Implications:
- This case highlights the importance of considering congenital aortic anomalies in hypertensive patients.
- Arterial revascularization is an effective surgical treatment for subisthmic aortic coarctation.
- Comprehensive diagnostic evaluation, including angiography, is essential for accurate assessment and management.
Abstract:
An uncommon case of high blood pressure secondary to subisthmic aortic coarctation and cured surgically by arterial revascularization is reported. It is probably a congenital coarctation, because the extensive clinical evaluation and condition of the patient ruled out an acquired disease of the aorta, confirmed by the morphologic operative findings and pathological examinations of the aortic wall. In this case, the clinical diagnosis was initially suggested due to an abdominal systolic-diastolic bruit, associated to hypertension and weak femoral pulses. Although doppler ultrasonography and nuclear magnetic resonance were useful diagnostic tools, a complete angiography should be performed because it is currently the most informative technique to evaluate the aorta and its collaterals, frequently involved in association with subisthmic aortic coarctation. Surgical exploration revealed a hypoplastic descending thoracic aorta and histological data confirmed the nonexistence of acquired pathology of the aortic wall. Surgical management was accomplished successfully and the patient was asymptomatic 41 months after the operation with normal blood pressure, no treatment, and a normal pattern of life. Based on this presentation, the authors describe the etiology, morphology and anatomic classification, clinical manifestations, diagnosis and management of subisthmic aortic coarctation.