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Cardiovascular Images

Coarctation of the Abdominal Aorta

An Uncommon Cause of Arterial Hypertension and Stroke

Fernando Daghero, MD; Nora Bueno, MD; Alejandro Peirone, MD; José Ochoa, MD; Gustavo Foa Torres, MD and Javier Ganame, MD, PhD

From Pediatric Cardiology (F.D., N.B.) and the Radiology Department (J.O.), Hospital Infantil; Pediatric Cardiology (A.P.), Hospital Privado; and the Radiology Department (G.F.T.), Instituto Oulton, Cordoba, Argentina; and the Cardiology Department (J.G.), University Hospitals Leuven, Belgium.

Correspondence to Javier Ganame, Cardiology Department, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. E-mail javier.ganame@uzleuven.be

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 14-year old male with no previous medical history presented with headache, left third cranial nerve palsy, and generalized tonic-clonic seizures. Magnetic resonance imaging of the brain revealed subarachnoid hemorrhage secondary to an aneurysm of the left posterior communicating artery. The patient underwent successful transcatheter coil occlusion of the aneurysm, and his neurological symptoms improved (Figure 1).

View larger version (78K):   Figure 1. A, Cerebral angiogram demonstrating a large ruptured aneurysm (arrow) of the posterior communicating artery. B, Angiogram after endovascular coil embolization showing exclusion of the aneurysm.

 
During admission, he remained hypertensive, with an arterial blood pressure of 170/96 mm Hg in the upper limbs despite medical treatment with atenolol, amlodipine, and enalapril. On physical examination, an abdominal systolic bruit was heard, and weak femoral pulses were noted. Blood pressure in the right and left arms was similar, but there was a significant differential pressure (50 mm Hg) compared with the lower limbs. Aortic coarctation and renal artery stenosis were considered to be the causes of arterial hypertension.

An echocardiogram showed moderate left ventricular hypertrophy and preserved systolic function. No abnormality in the aortic arch or proximal descending aorta was noted on echocardiography. An abdominal ultrasound showed a small abdominal aorta with diffuse narrowing and increased peak systolic velocity (509 cm/s). Presence of runoff flow throughout the entire diastole was also noted (Figure 2). Magnetic resonance angiography of the aorta confirmed the diagnosis of coarctation of the abdominal aorta and showed a narrowing of considerable length starting 5 cm . . . [Full Text of this Article]