Infantile Aortic Coarctation in an Adult with Heart Failure

Abstract

This focal narrowing constitutes an aortopathy that may present in a wide range of anomalies of the aortic arch and the abdominal aorta, from mild stenosis to even long hypoplastic segments. The most common location of AoC is near the insertion of the ductus arteriosus remnant in the proximal portion of the descending aorta, distal to the origin of the left subclavian artery [2] . AoC is classified into 2 different types based on its anatomical location: preductal or infantile and postductal, which is the most common form of presentation in adults [3] . Hence, the objective was to report such a case in order to emphasize the importance of excluding the presence of AoC in patients with a bicuspid aortic valve, even in old age. Case ReportA 56-year-old woman who presented with a history of hypertension was admitted to our hospital complaining of progressive dyspnea for the last 6 months. Physical examination revealed the presence of a pansystolic murmur at the aortic focus with irradiation to the carotid arteries and pulmonary rales. Electrocardiography showed signs of left ventricle hypertrophy. Laboratory results showed an elevated N-terminal pro-brain natriuretic peptide level, and a chest X-ray showed signs of pulmonary interstitial edema. The patient was admitted to the Department of Cardiology with a diagnosis of acute decompensated heart failure. Transthoracic echocardiography showed left ventricle hypertrophy with a normal left ventricle ejection fraction and a calcified, bicuspid aortic valve with severe stenosis (mean gradient 50 mm Keywords Aortic coarctation · Bicuspid aortic valve · Heart failure · Hypertension Abstract Objective: The aim of this case report is to highlight the importance of excluding aortic coarctation in a patient with a bicuspid aortic valve. Clinical Presentation and Intervention: A 56-year-old woman with hypertension was admitted complaining of progressive dyspnea. Transthoracic echocardiography showed a calcified, bicuspid aortic valve with severe stenosis. Aortography revealed the presence of severe narrowing of the aorta between the carotid and subclavian arteries. The patient was referred for cardiovascular surgery in which successful aortic valve replacement and aortic correction were performed. Conclusion: This case report shows an uncommon finding of infantile aortic coarctation in an adult patient admitted with heart failure.