Coarctation of Aorta - A case report

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Miss Sathi was treated by many anti-hypertensive drugs. But her hypertension was not being controlled. Latter it was diagnosed as a case of Coarctation of Aorta. It was then operated on. Post op events were uneventful. Now she is fine and no more anti-hypertensive drugs needed.

Published in: Health & Medicine, Sports

Coarctation of Aorta - A case report

  1. 1. Case Presentation PresenterDr. Hriday Ranjan Roy Assistant Professor, Surgery Rangpur Medical College Hospital
  2. 2. Case Presentation Miss Sathi, 24 years old, student, hailing from Kishoreganj, admitted into this hospital with the complaints of 1) Headache, dizziness and fatigue-2 years 2) Shortness of breath- 2 years. 3) Pain in leg after prolong walking- 2 years.
  3. 3. The patient states that she developed headache, dizziness and fatigue two years back. Symptoms gradually aggravated during last two years. She also felt tiredness and shortness of breath after walking or heavy works. It was also associated with leg cramps specially after walking prolong distance. She had no H/O rheumatic fever, asthma or cyanosis of lower limbs.
  4. 4. For these above complaints, she attended to local doctor and was diagnosed as a case of hypertension and absent of lower limb pulses. She had no family history of the same disease. Her menstrual history is normal. She used to take ARB (Losartan potassium) and Beta blocker (tenoren) to control her hypertension.
  5. 5. General examination on admission Appearance – normal No anemia, jaundice or cyanosis. No edema or dehydration. No clubbing or koilonychias. Neck glands- not palpable. JVP- not raised. Pulse- 80/min B.P- 185/95mmHG ( in arm) Leg- not recordable.
  6. 6. CVS examination Pulses Radial Brachial Axillary Carotid Femoral Popliteal Post. Tibial Dorsalis pedis Right + + + + - Left + + + + -
  7. 7. Precordium Inspection- Normal Palpation- Apex beat- left 5th ICS medial to midclavicular line. No parasternal heave. Auscultation- S1, S2- audible. Added sound- An ejection systolic murmur over left sternal border, more prominent over posterior interscapular region. Other system reveals no abnormality. Provisional diagnosis- Coarctation of aorta
  8. 8. Diagnostic workout    CXRP/A view- no cardiomegaly, no rib notching. LAO view- normal. ECG- normal. Echo- 2D & M modeLVIDd- 42mm, LVIDs-27mm, EF-62%, IVST- 10mm, PWT- 10mm, LA- 33mm, AO- 38mm, ACS- 16mm.
  9. 9. Echo (cont….) DescriptionLA, RA, RV, PA- Normal LV- mild concentric hypertrophy. AO- dilated. IAS, IVS- intact. MV- normal in appearance. AV- Bicuspid with mild reduction in cusp separation. A constriction suggestive of Coarctation of aorta seemed to be present distal to left subclavian artery. Impression1) Coarctation of aorta 2) Bicuspid aortic valve. 3) Mild concentric LV hypertrophy 4) Fair LV systolic function
  10. 10. Photograph of Echo
  11. 11. CXR P/A View
  12. 12. CXR lateral view
  13. 13. CXR LAO View
  14. 14. Cardiac catheterization (Sheldinger) PressureArch- 162/87mmHg Descending aorta- 101/76mmHg. Arch- There is a coarctation distal to the origin of left subclavian artery. No PDA seen. Descending aorta- Post stenotic dilatation. Both renal arteries are normal. Impression- Coarctation of aorta distal to left subclavian artery.
  15. 15. Cardiac catheterization
  16. 16. Biochemical investigations 1) 2) 3) 4) 5) 6) 7) 8) CBC- within normal limit. RBS- 6.2mmol/L Blood urea- 29mg% S. creatinine- 1.0mg% S. cholesterol- 137mg%. LDL- 75mg% HDL- 43mg% S. Triglyceride- 10mg%.
  17. 17. Confirmed diagnosis Coarctation of Aorta.
  18. 18. Surgery was done on 11/4/2007 under G/A. Incision- Left postero-lateral thoracotomy through 4 th ICS. Identification of coarctation (just distal to left subclavian artery). Dissection and control of aorta proximal and distal to coarctation as well as left subclavian artery. PDA was found distal to coarctation. Multiple ligation of PDA done (after reducing B.P with nitroprusside). Aortotomy, excision of posterior shelf and aortoplasty was done using PTFE onlay patch.
  19. 19. Patient position
  20. 20. Incision
  21. 21. Left lateral thoracotomy
  22. 22. Dissection and mobilization
  23. 23. Mobilization and control
  24. 24. The procedure ( internet)
  25. 25. Post operative CXR
  26. 26. Post operative periods 1) 2) Uneventful Hypertension was controlled by GTN. Outcome1) Immediate appearance of lower limb pulses. 2) Improvement of symptoms. 3) Reduction of anti-hypertensive drug doses. 4) Reduction of brachiocephalic hypertension.
  27. 27. She is Her happiness is our satisfaction happy
  28. 28. THANK YOU ALL

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