학술논문
An incidental finding of a bicuspid aortic valve and pseudocoarctation of the descending aorta in a patient presenting with an acute coronary syndrome: a case report.
Document Type
Report
Author
Vivekanantham H; Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland.; Cook S; Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland.; Stauffer JC; Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101730741 Publication Model: eCollection Cited Medium: Internet ISSN: 2514-2119 (Electronic) Linking ISSN: 25142119 NLM ISO Abbreviation: Eur Heart J Case Rep Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Aortic pseudocoarctation (PsCoA) is an elongation of the supra-isthmic aorta with kinking and low-grade narrowing. Consequently, no collateral circulation is found. It is frequently associated with other congenital heart anomalies, such as bicuspid aortic valve (BAV).
Case Summary: We report the case of 60-year-old patient who presented to the ED with acute chest pain. Physical examination was remarkable for an elevated blood pressure (BP) and the presence of a systolic murmur on the left lower sternal border. An acute coronary syndrome was suspected and the patient underwent urgent coronary angiogram which showed an occluded obtuse marginal artery. Additionally, the presence of an aortic anomaly was noted during the aortography, and additional work-up, including a thoracic computed tomography angiography and transoesophageal echocardiography, revealed a BAV and a PsCoA of the descending aorta. The patient was discharged after optimizing BP control with oral medication and periodical follow-up was arranged.
Discussion: Aortic PsCoA may mimic true coarctation (CoA), but the absence of a haemodynamically significant descending aortic narrowing and of the typical clinical findings associated with aortic CoA, distinguishes both entities. Treatment is therefore conservative and based on the control of cardiovascular risk factors and in particular of arterial hypertension. Work-up should include imaging of the entire aorta and the search for associated congenital cardiac anomalies, which, if present, should be managed in consequence.
(© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Case Summary: We report the case of 60-year-old patient who presented to the ED with acute chest pain. Physical examination was remarkable for an elevated blood pressure (BP) and the presence of a systolic murmur on the left lower sternal border. An acute coronary syndrome was suspected and the patient underwent urgent coronary angiogram which showed an occluded obtuse marginal artery. Additionally, the presence of an aortic anomaly was noted during the aortography, and additional work-up, including a thoracic computed tomography angiography and transoesophageal echocardiography, revealed a BAV and a PsCoA of the descending aorta. The patient was discharged after optimizing BP control with oral medication and periodical follow-up was arranged.
Discussion: Aortic PsCoA may mimic true coarctation (CoA), but the absence of a haemodynamically significant descending aortic narrowing and of the typical clinical findings associated with aortic CoA, distinguishes both entities. Treatment is therefore conservative and based on the control of cardiovascular risk factors and in particular of arterial hypertension. Work-up should include imaging of the entire aorta and the search for associated congenital cardiac anomalies, which, if present, should be managed in consequence.
(© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)