Caso 1/2013: homem de 20 anos com coartação nativa e evolutiva na croça da aorta

Abstract

KeywordsCoarctation of the aorta, aortic arch coarctation.Clinical data: After correction of severe aortic coarctation (AoC) in the isthmus through the end-to-end technique and closing of large Ventricular Septal Defect (VSD) with 18 days of life, in addition to correction of moderate subaortic stenosis with intraventricular pressure gradient of 40 mmHg with 3 years of age, a good clinical outcome was later observed. The patient currently tolerates routine exercising and does not refer any symptoms. Over time, he maintained upper and lower limb gradient between 10 and 15 mmHg and discreet systolic murmur in the aortic area by left ventricular outflow tract gradient around 15 mmHg. In the last routine evaluation, blood pressure in the right upper limb was 140 x 70 mmHg, and in the left upper and lower limbs, the systolic pressure was 90 mmHg, which characterized diagnosis of aortic arch obstruction between the upper limbs.Physical examination: Good general condition, eupneic, acyanotic, contrasting pulses between the right upper limb and the other ends. Weight: 65 Kg. Height: 165 cm, average systolic and diastolic blood pressure: 140/70 mmHg, PAMSE = PAMID = 90 mmHg, HR: 78 bpm. The aorta was clearly palpable palpable at the suprasternal notch with systolic fremitus and murmur of ++ intensity.In the precordium, apical impulse was not palpable and there were no systolic impulses. The heart sounds were normal and moderate systolic murmur of ++ intensity was harsh across the left sternal border, accompanied by fremitus. The liver was not palpable and the lungs were clear. Complementary testsElectrocardiogram showed sinus rhythm, signs of complete right bundle branch block and anterior superior division block of the left branch (unchanged since the neonatal correction of aortic coarctation and VSD). AP: +50 Chest radiograph showed normal and globular heart size on myocardial hypertrophy and normal pulmonary vasculature (Figure 1).Echocardiogram (Figure 1) showed cardiac cavities with normal dimensions, discrete myocardial hypertrophy (septum = posterior wall = 10 mm), left intraventricular pressure gradient of 15 mmHg in the left outflow tract and 58 mmHg in the aortic arch.