Coarctation of the aorta in adults: what is the best treatment? Case report and literature review

Abstract

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. We report the case of a 45 year-old women, diagnosed with severe coarctation of the aorta just distal to the left subclavian artery, with poststenotic dilatation of the descending aorta and difficult control of blood pressure values. The patient was successfully treated interventionally, by balloon angioplasty with deployment of a covered stent. We review here the different methods employed for the treatment of coarctation of the aorta in adults, including surgical or percutaneous balloon angioplasty with or without stent placement, underlying their complications and the factors that influence the choice of the best coarctation repair method.

Keywords: aortic coarctation; balloon angioplasty; covered stent; surgery.

Figure 1

Electrocardiogram. Sinus rythm, 62 bpm, without criteria for LVH.

Figure 2

Chest radiography. A Before stent placement and B After stent placement (see arrow for stent position)

Figure 3

A. Continuous Doppler echocardiography showing a peak systolic gradient of 69 mmHg and a low grade antegrade diastolic flow in the descending thoracic aorta (saw tooth), highly specific for significant aortic obstruction, before stent placement. B. Reduction of the peak systolic gradient at 29 mmHg after stent placement.

Figure 4

CT 3D images showing significant coarctation of the thoracic aorta beyond the origin of the left subclavian artery (arrow) with poststenotic dilatation and hypoplastic abdominal aorta

Figure 5

A, B, C. Deployment of a 41 mm long coverd stent mounted on a 16 mm balloon at the coarctation site. The balloon is inflated progressively. D. Aortography before stent placement (showing tight coarctation of the thoracic aorta just beneath the subclavian artery). E. aortography after stent placement.