Supersized Atheroma Causing Acquired Coarctation of Aorta Leading to Heart Failure

Abstract

Calcified atheromatous aortic lesion causing significant narrowing of the aorta is an uncommon clinical entity. This calcified atheroma leads to obstruction of the lumen of the aorta simulating acquired coarctation of aorta causing impaired perfusion of lower limbs, visceral ischemia, and hypertension. We report a case of 58-year-old patient who presented with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, 25-lb weight gain, lower extremity edema, and chest pain. Extensive workup including computed tomography and magnetic resonance imaging revealed a large calcific mass in the aortic arch causing his presenting symptoms. After surgical correction his symptoms resolved. Any patient presenting with heart failure symptoms in the setting of uncontrolled renovascular hypertension, intermittent claudication symptoms, or visceral ischemia with normal ejection fraction but moderate to severe left ventricular hypertrophy should be in high suspicion for acquired coarctation of aorta. The routine thorough examination of pulses in bilateral upper and lower extremities in all hypertensive patients is a very simple and useful clinical tool to diagnose acquired aortic coarctation.

First report of endovascular treatment of symptomatic coral reef aorta in the aortic arch

“…1 The 2 other cases, with maintained ejection fraction but myocardial hypertrophy, benefited from successful open surgery on the aortic arch. 2,3 In our case, open surgery was not conceivable due to the cardiac impairment. Given the favorable anatomy, we focused on endovascular management.…”

Ascending Aortic Coarctation — an Atypical Location in a Non-Takayasu Arteritis Female Patient

“…Atherosclerotic process is also among etiologies and in this condition the localization of the coarctation is mainly at the juxtorenal and suprarenal segments of the aorta [ 9 ] . Investigation of underlying factors which may have led to the formation of the atherosclerosis along the ascending aorta such as dyslipidemia, smoking, and hypertension, are not sufficient to justify the pathogenesis in such cases [ 10 ] . Disturbances of calcium metabolism and infectious agents affecting the vessel wall could be responsible for atherosclerotic processes of this extent, but further studies are required to determine the etiology [ 10 ] .…”

Giant Localized Atheroma Mimicking a Coarctation of the Aorta

“…Localized obstruction in a suprarenal aorta of normal diameter caused by an eccentric calcified lesion is exceptional in the literature. 3 Rare cases of acquired narrowing of the descending aorta due to coral reefs, which is a different entity, have also been mentioned with multiple calcifications. Based on rare reports, clinical presentation might then include lower limb claudication, signs of visceral ischemia, LV hypertrophy, or heart failure.…”

“…Based on rare reports, clinical presentation might then include lower limb claudication, signs of visceral ischemia, LV hypertrophy, or heart failure. 3 , 4 …”