Coarctation of the lower thoracic aorta - Case report and literature review

Aortic coarctation is an uncommon etiology for adult-onset hypertension. Fe w cases in the modern literature have been reported with lower thoracic aor tic coarctation as a cause for hypertension. A 36-year-old woman who had be en treated for 12 years with progressive hypertension presented to her loca l emergency room with worsening dyspnea on exertion and acute onset of left -sided chest and upper limb pain. Evaluation for myocardial infarction was negative; however an echocardiogram revealed concentric left ventricular hy pertrophy with severe global dyskinesia and an ejection fraction of 35%. Ca rdiac catheterization and aortography identified a lower thoracic aortic co arctation with a 90 mm Hg gradient and mild abnormalities of the coronary a rteries. There was no evidence of involvement of the visceral or renal arte ries. After stabilization of her blood pressure with nipride, nitroglycerin , and esmolol, she underwent a left posterolateral thoracotomy for aortic r epair using an interposition Dacron graft. Operative findings showed no evi dence of arteritis. Pathologic examination of a removed portion of the aort a revealed severe calcific atherosclerotic vascular disease and fibrosis in the adventitia with no evidence of active inflammation The patient was qui ckly weaned from intravenous antihypertensive medication postoperatively an d eventually discharged after a normal convalescence with diminished hypert ension.