A. Boutaleb , Y. Mekouar , A. Drighil , A. Boutaleb
{"title":"Adult complex aortic coarctation","authors":"A. Boutaleb , Y. Mekouar , A. Drighil , A. Boutaleb","doi":"10.1016/j.acvdsp.2023.07.047","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>Coarctation of the aorta<span> (CoA) is often associated with bicuspid aortic valve (BAV). Both count as the most frequent </span></span>congenital heart diseases and predispose to progressive valvular and aortic damage, leading to a higher morbimortality in undiagnosed patients. Rare cases of adult aortic coarctation lead to severely left ventricular impairment function so early diagnosis is crucial for prognosis improvement.</p></div><div><h3>Objective</h3><p>The objective of this case report is to highlight a rare form of late diagnosis of aortic coarctation discovered during heart failure with reduced ejection fraction (HFrEF) assessment.</p></div><div><h3>Results/Expected results</h3><p><span>A 60-year-old male presented to us with New York Heart Association functional class<span> III dyspnea and atypical chest pain<span>. On physical examination, he was found to have lower limbs pulse delay associated with asymmetrical blood pressure measurement<span><span> between the upper and lower limbs. The echocardiography revealed severe heart failure with reduced ejection fraction (HFrEF), a type 1 left right bicuspid aortic valve (BaV) with moderate </span>aortic stenosis (</span></span></span></span><span>Figure 1</span><span><span>), and severe coarctation of the aorta located in the aortic isthmus. The diagnosis was confirmed using computed tomography angiography, which allowed for a precise evaluation of the location and </span>anatomy<span> of the aorta. A pre-operative coronary angiography<span><span> revealed a smooth epicardial coronary artery tree. HFrEF secondary to long-term high afterload was diagnosed and treated with optimal medical therapy, and scheduled for percutaneous </span>balloon angioplasty of the aortic stenosis.</span></span></span></p></div><div><h3>Conclusion/Perspectives</h3><p><span>Despite the low prevalence of aortic coarctation among patients with adult congenital heart diseases, it should be screened </span>in patients presenting with refractory heart failure symptoms or persistent high blood pressure despite optimal medical treatment.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023002689","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Coarctation of the aorta (CoA) is often associated with bicuspid aortic valve (BAV). Both count as the most frequent congenital heart diseases and predispose to progressive valvular and aortic damage, leading to a higher morbimortality in undiagnosed patients. Rare cases of adult aortic coarctation lead to severely left ventricular impairment function so early diagnosis is crucial for prognosis improvement.
Objective
The objective of this case report is to highlight a rare form of late diagnosis of aortic coarctation discovered during heart failure with reduced ejection fraction (HFrEF) assessment.
Results/Expected results
A 60-year-old male presented to us with New York Heart Association functional class III dyspnea and atypical chest pain. On physical examination, he was found to have lower limbs pulse delay associated with asymmetrical blood pressure measurement between the upper and lower limbs. The echocardiography revealed severe heart failure with reduced ejection fraction (HFrEF), a type 1 left right bicuspid aortic valve (BaV) with moderate aortic stenosis (Figure 1), and severe coarctation of the aorta located in the aortic isthmus. The diagnosis was confirmed using computed tomography angiography, which allowed for a precise evaluation of the location and anatomy of the aorta. A pre-operative coronary angiography revealed a smooth epicardial coronary artery tree. HFrEF secondary to long-term high afterload was diagnosed and treated with optimal medical therapy, and scheduled for percutaneous balloon angioplasty of the aortic stenosis.
Conclusion/Perspectives
Despite the low prevalence of aortic coarctation among patients with adult congenital heart diseases, it should be screened in patients presenting with refractory heart failure symptoms or persistent high blood pressure despite optimal medical treatment.
期刊介绍:
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.