Chest
Clinical Problems in Cardiopulmonary DiseaseCoarctation of the Aorta in an Adult: Problems of Diagnosis and Management
Section snippets
Case Report
A 41-year-old man was initially evaluated 6 years previously by his family physician, found to be hypertensive, and managed with pharmacologic agents. Over the next several years, control of his BP became increasingly difficult, requiring multiple agents. He was referred to a cardiologist for further evaluation. Throughout the entire period, he has remained asymptomatic.
The patient’s history revealed that 3 years ago, he underwent echocardiography, which disclosed a strong likelihood of a
Questions for Consultants
- 1.
What treatment would you recommend for this man?
- 2.
What are the pros and cons for surgical correction vs stent implantation to correct this defect?
- 3.
If mechanical intervention corrected the coarcted aortic segment, what is the likelihood that his hypertension would be cured or ameliorated?
- 4.
If this patient were to refuse any type of mechanical intervention in favor of attempts at more effective pharmacological control of the BP, what would be the likely long-term risk and outcome of this strategy?
What treatment would you recommend for this man?
All patients with significant coarctation, including those with proximal systemic hypertension, whether symptomatic or asymptomatic, warrant intervention.1 A coarctation is considered significant if the gradient is > 20 mm Hg between arm and leg by BP cuff with or without proximal systemic hypertension, or in the presence of upper-extremity hypertension accompanied by echocardiographic or angiographic evidence of aortic obstruction.2 This patient has increasingly difficult control of BP
References (5)
- et al.
Canadian Cardiovascular Society Consensus Conference 2001 update: recommendations for the management of adults with congenital heart disease; part I
Can J Cardiol
(2001) - et al.
Adult congenital heart disease
Cited by (8)
Aortic Disease
2009, Atlas of Cardiovascular Computed TomographyLong-term results of surgical coarctectomy in the adolescent and young adult with 18-year follow-up
2005, Annals of Thoracic SurgeryImaging of the thoracic aorta in adults: When, how and why?
2004, Journal de RadiologieLate diagnosis of congenital cardiovascular defect
2012, Cardiology JournalDelayed diagnosis of coarctation of aorta in young adolescents
2009, Polski Przeglad Kardiologiczny