Adolescences Hypertension: A Late Case of Coarctation of Aorta: A Case Report and Short Review of Literature

Abstract

Coarctation of the Aorta (CoA) is a common Congenital Heart Disease (CHD) presenting with many symptoms and signs, in any age group. From its dramatic appearance as a part of Hypoplastic Left Heart Syndrome(HLHS), to early Congestive Heart Failure(CHF)in neonatal and early infantile age, to undetected Hypertension (HTN) in adolescence or even late adulthood. The aim of this case report and short review is to present this unique CHD, underline the presentation of late detected CoA, the use of cardiac CT to assess severity and plan surgical treatment. Finally, to discuss the bourdon of treating resistant HTN even after successful surgical treatment. This difficult to control by pharmacotherapy, HTN and the late complications of persistent uncontrolled HTN for the Cardiovascular System(CVS), are the principle reasons for these patients to have a long-life follow-up. This population, while aging, will face important and increasing morbidity and mortality.

Implantation of Covered Stent for Coarctation of the Aorta and Secondary Hypertension in Adolescents—Case Report

“…The care of patients with this pathology depends on a series of factors such as the severity of the stenosis, age of the patient, and clinical manifestations. Both in children and in adults, delay in diagnosis can occur due to normal development and lack of symptoms [3][4][5]. The diagnosis is often incidental due to the presence of a systolic murmur and/or increased blood pressure values [2][3][4][5].…”

“…Both in children and in adults, delay in diagnosis can occur due to normal development and lack of symptoms [3][4][5]. The diagnosis is often incidental due to the presence of a systolic murmur and/or increased blood pressure values [2][3][4][5]. The presumptive CoA diagnosis can be based on the following clinical symptoms: weak/absent femoral pulse, systolic murmur, and blood pressure (BP) difference ≥20 mmHg between superior and inferior limbs.…”

“…The presumptive CoA diagnosis can be based on the following clinical symptoms: weak/absent femoral pulse, systolic murmur, and blood pressure (BP) difference ≥20 mmHg between superior and inferior limbs. Moreover, the patient might complain of signs and symptoms related to arterial hypertension (AHT) such as headache, dizziness, epistaxis, or inferior-limb pains during physical effort [2,5]. Transthoracic echocardiography and thoracic computed tomography angiography (CTA) allow the accurate assessment of CoA anatomy [5][6][7][8].…”

“…Moreover, the patient might complain of signs and symptoms related to arterial hypertension (AHT) such as headache, dizziness, epistaxis, or inferior-limb pains during physical effort [2,5]. Transthoracic echocardiography and thoracic computed tomography angiography (CTA) allow the accurate assessment of CoA anatomy [5][6][7][8].…”

“…Options include surgery or percutaneous treatment [3]. Hypertensive patients with CoA and with BP differences ≥20 mmHg have an indication for surgical or interventional treatment [5]. The accurate assessment of the coarctation area and its surrounding anatomy is mandatory for establishing the type of coarctation [1,5,9,10].…”