Aortic Coarctation

Abstract

Coarctation of the aorta is a relatively common congenital heart disease, affecting approximately 3 per 100,000 births, predominantly in males. It is a heterogeneous lesion that results in segmental narrowing of the aorta, especially in the distal segment to the origin of the left subclavian artery. The clinical manifestations depend on the location and severity of the obstruction, ranging from an asymptomatic to a secondary hypertension – present in two-thirds of the children with this condition. Chest X-ray, electrocardiogram, and echocardiogram may reveal signs of coarctation, but angiotomography and/or angiography should be used to define the site and extent of the lesion. Candidate patients for treatment are those symptomatic or asymptomatic with a pressure gradient between the upper and lower limbs greater than 20 mmHg. The intervention may be via open surgery, with preference for the end-to-end anastomosis and subclavian flap technique, or endovascular approach, with balloon angioplasty and, in some cases, stent implantation. Despite the low morbidity and mortality of these procedures, they are not free of possible adverse outcomes, and follow-up of the patients submitted to them is essential for the detection of some complications. We report a case of a male patient, with a clinical condition of severe headache, arterial hypertension, and lower limb pulsation, with aortic coarctation. Endovascular treatment was performed through balloon angioplasty. During the procedure, an aneurysm formed, which was immediately corrected with the placement of a stent. After angioplasty, the patient presented blood pressure normalization and absence of a gradient between the upper and lower limbs. The patient was discharged in 2 days, with a prescription of ASA and clopidogrel for 6 months, as well as guidelines for outpatient follow-up for an indeterminate period.