Severe Coronary Artery Disease and Nearly Atretic Aortic Coarctation in a Young Woman

Abstract

Background: Coarctation of the aorta is associated with long-term cardiovascular complications, including hypertension and early onset atherosclerosis.

Case summary: A 36-year-old woman with persistent hypertension after preeclampsia presented with chest pain. Electrocardiogram showed left ventricular hypertrophy with signs of ischemia. Echocardiography revealed a bicuspid aortic valve; however, the aortic arch was poorly seen. Coronary computed tomography identified severe left anterior descending artery stenosis with thoracic collaterals. During angioplasty, guidewire misdirection uncovered nearly atretic aortic coarctation, successfully stented a few days later.

Discussion: This case illustrates how aortic coarctation can remain undetected until adulthood. It causes long-term cardiovascular complications through chronic hypertension and vascular dysfunction, promoting early coronary artery disease. Besides classical risk factors, Turner syndrome, the shape of the aortic arch, as well as the timing and method of repair, also appear to be additional risk factors.

Take-home messages: Aortic coarctation is an aortopathy that leads to early atherosclerosis and coronary artery disease. Comprehensive evaluation is essential for timely diagnosis and optimal management.

Keywords: aortic coarctation; atherosclerosis; coronary angiography; coronary vessel anomaly; hypertension; myocardial revascularization; percutaneous coronary intervention; stents.