Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Coarctation of the aorta presenting as systemic hypertension in a young adult

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 484–488 (2008)Cite this article

Abstract

Background A 20-year-old male presented with a history of systemic hypertension. Examination revealed a systolic murmur with an early ejection click, and femoral pulses were markedly reduced.

Investigations Physical examination, laboratory testing, electrocardiography, chest radiography, comprehensive echocardiography including pulsed-wave Doppler examination, and CT of the chest.

Diagnosis Severe coarctation of the juxtaductal aorta accompanied by an ascending aortic aneurysm, a bicuspid aortic valve without evidence of hemodynamically significant stenosis or regurgitation, and an atrial septal defect.

Management An ascending–descending intrapericardial aortic bypass graft, atrial septal defect closure, and ascending aorta replacement were all successfully performed. Lifelong follow-up will be required.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Chest radiograph of the patient demonstrating cardiomegaly, features of ascending aortic enlargement (black arrow), and findings consistent with aortic coarctation with bilateral rib notching (white arrow).
Figure 2: Imaging studies, performed on the patient at presentation, demonstrated findings that were compatible with severe coarctation of the aorta.
Figure 3: Chest CT scan with three-dimensional reconstruction, demonstrating severe coarctation of the patient's aorta and the presence of large collateral vessels.
Figure 4: An ascending–descending intrapericardial aortic bypass graft was used to repair the patient's complex aortic coarctation.

References

  1. Perloff JK (2003) Clinical Recognition of Congenital Heart Disease, edn 5. Philadelphia: Saunders

    Google Scholar 

  2. Rao PS (2005) Coarctation of the aorta. Curr Cardiol Rep 7: 425–434

    Article  Google Scholar 

  3. Warnes CA (2003) Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart 89: 965–966

    Article  CAS  Google Scholar 

  4. Horlick EM et al. (2007) The adult with repaired coarctation of the aorta. Curr Cardiol Rep 9: 323–330

    Article  Google Scholar 

  5. Connolly HM et al. (2003) Intracranial aneurysms in patients with coarctation of the aorta: a prospective magnetic resonance angiographic study of 100 patients. Mayo Clin Proc 78: 1491–1499

    Article  Google Scholar 

  6. Reifenstein GH et al. (1947) Coarctation of the aorta: a review of 104 autopsied cases of the “adult type” 2 years of age or older. Am Heart J 33: 146–168

    Article  CAS  Google Scholar 

  7. Campbell M (1973) Incidence of cardiac malformations at birth and later, and neonatal mortality. Br Heart J 35: 189–200

    Article  CAS  Google Scholar 

  8. Massey R and Shore DF (2004) Surgery for complex coarctation of the aorta. Int J Cardiol 97 (Suppl 1): 67–73

    Article  Google Scholar 

  9. Attenhofer Jost CH et al. (2002) Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. Mayo Clin Proc 77: 646–653

    Article  Google Scholar 

  10. Connolly HM et al. (2001) Posterior pericardial ascending-to-descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta. Circulation 104 (Suppl 1): I133–I137

    Article  CAS  Google Scholar 

  11. McKellar SH et al. (2007) Intermediate-term results of ascending–descending posterior pericardial bypass of complex aortic coarctation. J Thorac Cardiovasc Surg 133: 1504–1509

    Article  Google Scholar 

  12. Golden AB and Hellenbrand WE (2007) Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv 69: 289–299

    Article  Google Scholar 

  13. Cohen M et al. (1989) Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical correction. Circulation 80: 840–845

    Article  CAS  Google Scholar 

  14. Presbitero P et al. (1987) Long-term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 57: 462–467

    Article  CAS  Google Scholar 

  15. Gardiner HM et al. (1994) Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 89: 1745–1750

    Article  CAS  Google Scholar 

  16. Warnes CA (2005) The adult with congenital heart disease: born to be bad. J Am Coll Cardiol 46: 1–8

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. JR Alegria is an Assistant Professor of Medicine at the University of Kentucky, Lexington, KY,

    Jorge R Alegria

  2. HM Burkhart is Associate Professor of Surgery in the Division of Cardiovascular Surgery and HM Connolly is Professor of Medicine in the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,

    Harold M Burkhart & Heidi M Connolly

Authors
  1. Jorge R Alegria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harold M Burkhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heidi M Connolly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heidi M Connolly.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alegria, J., Burkhart, H. & Connolly, H. Coarctation of the aorta presenting as systemic hypertension in a young adult. Nat Rev Cardiol 5, 484–488 (2008). https://doi.org/10.1038/ncpcardio1258

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1258

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing