Aortic coarctation is a segmental narrowing of the descending aorta which commonly located distally to the origin of the left subclavian artery.[1] This congenital anomaly is frequently diagnosed and treated in childhood; however, it can be left undiagnosed until adulthood.[2] In this article, we present a 55-year-old female case with severe aortic coarctation with 30 mmHg gradient, distal to the origin of the subclavian artery with post-stenotic dilatation (Figure 1). Computed tomography angiography revealed calcification and aortic wall irregularities of pre-coarctation segment (Figure 2a) despite no changes in post-coarctation segment (Figure 2b). She was on anti-hypertensive therapy for almost 20 years. Transthoracic echocardiography revealed severe aortic valve stenosis with a mean gradient of 52 mmHg and 42 mm ascending aorta. The patient underwent graft bypass surgery with left posterolateral thoracotomy. A 16 polytetrafluoroethylene tubular graft was anastomosed distally to the origin of the left subclavian artery using side biting clamp and distal part of the graft was anastomosed beneath the aneurysmatic segment of the descending aorta. Postoperative period was uneventful. Beta-blocker monotherapy was used to control the blood pressure. Surgery was planned for aortic valve disease. Aortic coarctation is rarely seen in adult patients. Graft bypass is a safe and effective treatment.

Figure 1: Computed tomography angiography showing severe aortic coarctation and poststenotic dilatation.

Figure 2: Computed tomography angiography of precoarctation and post-coarctation segment (2a: Arrow shows calcification and wall irregularities of pre-coarctation segment, 2b: There is no changes on aortic wall of post-coarctation segment).

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

References

1) Leetmaa TH, Nørgaard BL, Mølgaard H, Jensen JM. Severe aortic coarctation in an adult patient with normal brachial blood pressure. J Clin Imaging Sci 2014;4:41.

2) Jurcut R, Daraban AM, Lorber A, Deleanu D, Amzulescu MS, Zara C, et al. Coarctation of the aorta in adults: what is the best treatment? Case report and literature review. J Med Life 2011;4:189-95.