Coarctation of aorta with complete aortic occlusion
An 81-year-old man was referred to our clinic for evaluation and treatment of typical angina during exercise. His medical history included arterial hypertension for many years; there was no history of traumatic injury or Takayasu's arteriitis. He was otherwise asymptomatic. On physical examination, the blood pressure was 140/85 mmHg in both arms. The lower extremity pulses were diminished and delayed. The patient denied symptoms of claudication and weakness of his legs and reported to walk more than one kilometer without any problems. Results of routine blood chemistry and urine analysis were normal. Electrocardiography revealed left ventricular hypertrophy without evidence of prior myocardial infarction. Chest X-ray demonstrated typical rib notching ().\nConcentric left ventricular hypertrophy, a normal tricuspid aortic valve, a normal mitral valve, and normal left ventricular systolic function could be demonstrated on echocardiographic examination. However, the distal part of the aortic arch was not adequately visualizable. Coronary angiography () was performed via the radial route, and severe triple-vessel disease was detected (SYNTAX (SYNergy between PCI with TAXUS™ and Cardiac Surgery) Score of 35 points).\nAortography () revealed a postductal CoA with total occlusion of the aortic arch. Simultaneous pressure tracings in the aortic arch and the descending aorta demonstrated a pressure gradient of 70 mmHg. There was no evidence of clot formation in the blind end of the aorta distal to the coarctation.\nMagnetic resonance (MR) angiography was performed and confirmed the aortic occlusion just below the origin of the left subclavian artery, showed slight post-stenotic dilatation, and distinct collateral circulation ().\nCranial MR was without evidence of intracerebral aneurysm. The patient refused operative treatment of his triple-vessel coronary artery disease, and underwent finally a staged percutaneous coronary intervention procedure. Surgical correction of the CoA was not performed because the patient was asymptomatic with a good exercise tolerance and his hypertension was well controlled with a combination of three antihypertensive agents (β-blocker, diuretic, and angiotensin-receptor-blocker). At clinical follow-up after 8 months the patient remained free of symptoms.