Improvement of left ventricular systolic function after surgical repair for adult aortic coarctation

Abstract

We report a case of aortic coarctation complicated by type B aortic dissection in an elderly patient, whose left ventricular (LV) systolic dysfunction improved after surgical repair. A 71-year-old male presented with back pain, and contrast-enhanced computed tomography (CT) revealed aortic coarctation and aortic dissection. The aortic dissection was uncomplicated type B, so the patient was managed conservatively. Transthoracic echocardiography (TTE) on admission showed eccentric hypertrophy in the Lang classification. LV wall motion was diffusely impaired, with an LV ejection fraction (EF) of 27 %. Parachute-like morphology of mitral valve and mild mitral stenosis, with an elevation of an E/e′ ratio of 32.6, were also recognized. Three months later, CT revealed rapid expansion of the descending aorta, so the patient underwent resection of the coarctated segment and a graft replacement of the descending aorta. TTE three months postoperatively revealed normalization of LV systolic function, with an LVEF of 58 %, and of LV dilatation, and regression of hypertrophy, along with decrease in an E/e′ ratio of 19.5. Preoperative LV systolic dysfunction seems to be attributed to afterload mismatch. Two years after the surgery, the patient remains in good health without experiencing heart failure or any aortic-related events.

Learning objective

The prognosis of adult aortic coarctation is poor, with the impact on cardiac function due to chronic increased afterload. We present a case of aortic coarctation in an elderly patient, whose left ventricular systolic dysfunction improved after surgical repair. We considered that surgical repair of aortic coarctation resolved eccentric hypertrophy and corrected the afterload mismatch that existed preoperatively, leading to improvement in left ventricular systolic function.