POST-DUCTAL COARCTATION OF AORTA
FINDINGS:
Bicuspid aortic valve (type 0 – AP).
Mild thickening of aortic valve leaflets.
Post-ductal coarctation of aorta with severe narrowing of the caliber of distal arch of aorta for a length of ~ 5 mm and having narrowest diameter of 2.3 x 0.8 mm.
No evidence of narrowing of caliber of left subclavian artery.
No evidence of hypoplasia of aortic arch.
Multiple dilated chest wall arterial collaterals in the form of dilated bilateral internal mammary arteries, dilated superior & inferior epigastric arteries, dilated phrenic arteries, dilated upper posterior intercostal arteries and paraspinal arteries.
Concentric hypertrophy of left ventricle.
Discussion:
Aortic coarctation (CoA) is defined as a narrowing of the thoracic aorta.
It can occur in association with other congenital heart defects, such as bicuspid aortic valve (60%), aortic arch hypoplasia or other arch anomalies (18%), ventricular septal defect (13%), mitral valve abnormalities (8%), subaortic stenosis (6%), among others.
Most patients are asymptomatic. However, some may present with severe hypertension leading to headaches, epistaxis, heart failure, and/or aortic dissection. Patients who are normotensive at rest, should be tested for exercise-induce hypertension through a cardiopulmonary exercise test witha treadmill ergometer using an incremental protocol (Naughton protocol or the modified Bruce protocol).
Multidetector computed tomography (MDCT) angiography with multiplanar and three-dimensional techniques is a non-invasive method for characterizing the location, degree and length of the narrowing, relationship to the left subclavian artery, presence of collateral circulation and associated cardiovascular abnormalities
