Iatrogenic Aortic Coarctation
A 35-year-old male was admitted because of arterial hypertension in the upper part of the body (230/100 mm Hg on the right arm) with a pressure difference of 50 mm Hg between the right and left arms and 80 mm Hg between the right arm and right leg. Three weeks earlier, he had undergone emergency aortic stenting for traumatic dissection at the aortic isthmus after a 3-story fall. Transthoracic echocardiography from the suprasternal window revealed the proximal part of the stent protruding into the aortic arch and high-velocity flow (4.4 m/s, pressure gradient 78 mm Hg) in the proximal descending aorta, with a spectrum typical for aortic coarctation (Figure 1A). Moreover, the blood-flow pattern in the abdominal aorta was characteristic of proximal stenosis, with slowing of the systolic upstroke and persistent diastolic flow (Figure 1B). Spiral computed tomography confirmed the diagnosis of aortic coarctation secondary to malapposition of the proximal part of the stent (Figure 1C, arrow). During subsequent surgery, with the use of circulatory arrest, the stent was repositioned and the aortic arch was widened with a 3×6-cm patch. Postoperative transthoracic echocardiography revealed normalization of flow in the descending and abdominal aorta (Figure 2A and 2B), with widening of the aortic arch lumen on computed tomography examination (Figure 2C). The right arm–right leg blood pressure difference diminished to 20 mm Hg. However, the blood pressure difference between the right and left arms persisted because of partial occlusion of the left subclavian artery by the aortic stent.