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The New England Journal of MedicineAortic Coarctation

Coarctation of the Aorta: Critical Observations and Surgical Intervention Enhancing Patient Outcomes

In a revealing case of aortic coarctation in a 35-year-old man, initial signs of undiagnosed hypertension were first noted during a routine medical screening. Subsequent detailed imaging and successful percutaneous stenting highlight the critical importance of early detection and intervention in managing this potentially life-threatening condition. This case provides key insights into the anatomical and physiological implications of aortic coarctation, emphasizing the nuanced approach required for effective treatment.

Key Points:

  • Patient Presentation: A 35-year-old male, asymptomatic with hypertension identified during a routine screening, showing a blood pressure discrepancy between arms and legs, indicative of aortic coarctation.
  • Diagnostic Imaging: CT angiography revealed a significantly narrowed aortic isthmus, extensive collateral arterial circulation, and specific radiographic signs such as notched ribs and widened paratracheal stripes.
  • Surgical Intervention: The patient underwent successful percutaneous stenting of the coarctation, leading to notable improvements in blood pressure and arterial circulation.
  • Follow-Up Results: Post-surgery, the patient showed a marked reduction in collateral arterial circulation and sustained improvement in blood pressure over a three-month period.
  • Implications for Practice: This case underscores the need for vigilant screening for aortic coarctation in patients with unexplained hypertension, particularly if blood pressure discrepancies and radial-femoral delay are observed.

Aortic coarctation was first described by Thiene in 1760 and accounts for 4%-6% of all congenital heart defects, with an incidence is of 3-4 cases per 10,000 live births. Males are commonly affected than females with a ratio between 1.27:1 and 1.74:1, respectively. (World Journal of Cardiology)

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