Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#17 COARCTATION OF THE LOWER THORACIC AORTA: AN UNUSUAL LOCATION
Jeffrey D. Kerby, MD, PhD and William D. Jordan, MD
The University of Alabama at Birmingham, Birmingham, AL
Aortic coarctation is an uncommon etiology for adult-onset hypertension. Only 2 cases have previously been reported with lower thoracic aortic coarctation as a cause for hypertension. A 35 year old black female who had been treated for 12 years with progressive hypertension, presented to her local emergency room with worsening syspnea on exertion and acute onset of left sided chest and arm pain. Evaluation for myocardial infarction was negative, however echocardiogram revealed concentric left ventricular hypertrophy with severe global dyskinesia and an ejection fraction of thirty-five percent. Cardiac catheterization identified a lower thoracic aortic coarctation with a 90 mmHg gradient and normal coronary arteries. There was no evidence for involvement of the visceral or renal arteries. After stabilization of her blood pressure with nipride, nitroglycerin, and esmolol, guided by a pulmonary artery catheter, she underwent a left postero-lateral thoracotomy for aortic repair using an interposition dacron graft. Operative findings showed no evidence of arteritis. Pathologic examination of a removed portion of the aorta revealed nonspecific fibrosis of the aortic wall, supporting a congenital etiology for this lesion. The patient was quickly weaned from intravenous anti-hypertensive medication postoperatively and eventually discharged after a normal convalescence with improved hypertension.
This case is unique not only for its delayed presentation, but also for the unusual location in the distal thoracic aorta. Coarctation of the thoracic aorta usually occurs at the level of the insertion of the ductus arteriosus. Coarctation isolated to distal thoracic aorta is rare. Definitive management of these lesions requires anatomic surgical repair with interposition grafts of aortoaortic bypass.
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Last updated January 10, 1999