Coarctation of the aorta associated with bicuspid valve and aortic aneurism
Juan Quiles, MD, Pablo Avanzas, MD, Roberto Muñoz, MD.
Department of Cardiology. Hospital General Universitario Gregorio Marañón. Madrid. Spain.
A 55 year old hypertensive man with previously diagnosed coarctation of the aorta and hypertensive was admitted to hospital with heart failure. Shortness of breath on exertion progressed to resting dyspnea in the month prior to admission. On clinical examination he was hypertensive and physical examination showed a difference in blood pressure between both arms, diastolic murmur, large volume carotid pulses and low volume femoral pulses. Echocardiography showed a regurgitant bicuspid aortic valve, severe dilatation of the ascending aorta and severely depressed ejection fraction. Spiral CT with 3D reconstruction confirmed the coarctation (black arrow) located distally to the origin of left subclavian artery with a maximum transverse diameter of 0.5 cm and dilatation of the ascending aorta. Cardiac catheterization confirmed aortic regurgitation and this was graded as severe. The mean pressure gradient across the coarctation was 30 mmHg.
Figure legend
Three-dimensional spiral CT showing the coarctation of the aorta (arrow) located distally to the left subclavian artery origin. AA: ascending aorta; DA: descending aorta; LS: left subclavian artery; LV: left ventricle.
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