(Circulation. 1999;100:e51-e52.)
© 1999 American Heart Association, Inc.
Circulation Electronic Pages |
Delayed Diagnosis of Aortic Coarctation
The Third Medical Visit
From the Department of Internal Medicine (G.A., P.M., J.B., X.G., M.E.S.) and the Department of Cardiovascular and Thoracic Surgery (J.-P.C.), Broussais Hospital, Paris, France.
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Introduction |
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 Top Introduction |
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Ablack male native of Côte d'Ivoire (West Africa) met a doctor for the first time at age 3 because of an inability to walk. A traditional African medical practitioner left the parents with little hope. Nevertheless, the patient was finally able to walk but continued to suffer an inability to run.
His second meeting with a doctor was at age 30 in the intensive care unit of Abidjan Hospital, Côte d'Ivoire, because of a stroke, with left hemiplegia and coma, associated with high blood pressure. He was discharged from the hospital 15 days later on an antihypertensive drug. The neurological recovery was complete 1 year later.
During a checkup after 16 years of no medical examinations, French immigration physicians found high blood pressure and heart murmur, leading to the transfer of the patient to our Cardiovascular Department. This was his third medical visit.
Because of high blood pressure, asymmetry of blood pressure
between the 2 arms, systolic heart murmur, increased carotid
pulses, and decreased femoral pulses, aortic coarctation was suspected.
MRI angiography (Figure 1
) and spiral CT
(Figure 2) confirmed the diagnosis. A
left subclavian artery aneurysm was also found, which explained
the initial chest radiographic image (Figure 3). Additional supra-aortic vascular
abnormalities were found, along with a collector trunk replacing the
innominate artery and common left carotid artery (Figure 2).
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Reconstructive surgery was very difficult because of tremendous
collateral circulation (Figure 1
). The coarctation was resected
with the adjacent aneurysmal emergence of the left subclavian
artery (Figure 4). A tubular
prosthesis was implanted, with the proximal anastomosis
performed at the takeoff of the collector trunk and the distal
anastomosis performed to the descending aorta. The left subclavian
artery was not reimplanted because its residual pressure was equal to
the systemic blood pressure. Postoperative spiral CT images were
satisfactory (Figure 5).
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At a follow-up visit at 8 months, blood pressure was 110/70 mm Hg in both arms without use of any antihypertensive drugs.
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Acknowledgments |
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The authors wish to thank Prof Gaux and Dr Maisseaux of the Radiology department, Brovssais Hospital.
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Footnotes |
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Reprint requests to Prof Michel E. Safar, Médecine 1, Broussais Hospital, 96, rue Didot, 75014 Paris, France.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
This article has been cited by other articles:
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  N Hiller, A Verstanding, and N Simanovsky Coarctation of the aorta associated with aneurysm of the left subclavian artery Br. J. Radiol., April 1, 2004; 77(916): 335 - 337. [Abstract] [Full Text] [PDF]
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