Giant descending aortic pseudo-aneurysm in an adult man with uncorrected aortic coarctation

Abstract

Background: Aortic coarctation (CoAo) accounts for 6 to 8% of all congenital heart diseases and occurs two to five times more often in males. The uncorrected aortic coarctation is complicated by hypertension, ascending and descending aortic aneurysms, endarteritis, and heart failure. The aortic pseudo-aneurysm (APD) usually occurs in patients with endarteritis. We report an adult man with bicuspid aortic valve, perimembranous ventricular septal defect, and uncorrected aortic coarctation complicated by descending aortic pseudo-aneurysm without aortic endarteritis.

Case presentation: A 40-year-old man was referred to our division for hemoptysis and severe aortic coarctation. Echocardiography confirmed the aortic coarctation diagnosis and showed a large aortic pseudo-aneurysm at the coarctation site with intra-cavity mural thrombus. Subsequently, the patient underwent contrast-enhanced computed tomography angiography, and diagnosis of coarctation and APD was confirmed. Due to various malformations and considering that the patient had become unstable due to hemoptysis, it was discussed in the heart team, and it was decided that the patient would undergo staged surgery.

Conclusions: The aortic pseudo-aneurysm is a rare complication in patients with untreated coarctation that requires prompt surgery, and this complication should be considered in patients with untreated aortic coarctation who present with hemoptysis.

Keywords: Aortic coarctation; Aortic pseudo-aneurysm; Echocardiography.

Fig. 1

2D-TEE, Color-coded M-mode showing the aortic insufficiency (AI) signal during diastole, and the perimembranous VSD signal during systole

Fig. 2

2D-TEE shows a large pseudo-aneurysm at the coarctation site with intra-cavity mural thrombus (APD aortic pseudo-aneurysm)

Fig. 3

2D Computed tomography angiography scan shows a severe aortic coarctation and a giant pseudo-aneurysm at coarctation site (CoAo aortic coarctation, APD aortic pseudo-aneurysm)

Fig. 4

2D computed tomography angiography scan, axial views, shows the 52 × 55 mm pseudo-aneurysm with a small neck communicated to the aortic lumen (APD aortic pseudo-aneurysm)