Late diagnosis of a congenital coronary anomaly

A 64-year-old woman with a history of atrial fibrillation, hypertension, and sarcoidosis presented to the emergency department with chest pain. After a positive stress test, a coronary angiogram was performed, which showed normal coronary arteries except for an anomalous take-off of the left circumflex artery from the right coronary cusp. To better evaluate the vessel, a 64-slice computed tomography (CT) angiogram was performed, which showed a benign course; however, an incidental finding was noted (Figures 1 and 2).

Case report

Figures. 64-slice CT angiogram showing coarctation of the aorta (arrow) at the junction of the posterior aspect of the aortic arch and poststenotic dilatation of the descending aorta (top). 64-slice 3D volume-rendered CT angiogram showing coarctation of the aorta (arrows) at the junction of the posterior aspect of the aortic arch and descending aorta (bottom).

Coarctation of the aorta at the junction of the posterior aspect of the aortic arch and descending aorta. Poststenotic dilatation of the proximal descending thoracic aorta is also visible.

Points to remember

Coarctation of the aorta, abbreviated in the literature as CoA, is a narrowing of the aorta, which results in restricted blood flow and can lead to hypertension in the upper extremities and congestive heart failure. The condition accounts for 5% to 10% of all congenital heart defects. It may occur alone or in combination with other defects, such as a bicuspid aortic valve, ventricular septal defects, patent ductus arteriosus, aortic valve stenosis, and mitral valve stenosis. Although the condition is usually diagnosed in infants, if mild, it may not be diagnosed until adulthood; however, most cases are diagnosed before age 40 years, which makes our patient’s case very unusual. Symptoms, especially in older individuals, are nonspecific and may include hypertension, dyspnea, chest pain, nosebleeds, leg cramps and/or cold feet, and muscle weakness. Treatment is typically interventional using balloon angioplasty with stent placement or surgery. We recommended stent placement at the coarctation site to our patient, but she declined this intervention because she was concerned about potential risks. The most common potential complications for patients who have not had an intervention include hypertension, aortic rupture, intracranial bleeding, and congestive heart failure. Women who have an uncorrected coarctation of the aorta have a mortality rate of 10% during pregnancy and a 90% rate of complications.

Disclosure

The author has no relationship with any commercial entity that might represent a conflict of interest with the content of this report.