A CLINICAL CASE OF SECONDARY HYPERTENSION IN A 20-YEAR-OLD FEMALE WITH COARCTATION OF THE AORTA

Abstract

Objective: Coarctation of the aorta (CoA) is a curable cause of secondary hypertension. Patients with CoA and associated heart disease typically are diagnosed in childhood, while isolated CoA may not be recognized until adulthood. Design and method: We report a case of diagnosis and treatment of CoA in a young female, previously observed with a diagnosis of essential hypertension. Results: A 20 years old female, diagnosed with hypertension at the age of 18, with difficult control of blood pressure (BP) values under treatment with angiotensin-converting enzyme inhibitors, beta-blockers and diuretics. The patient was referred to our clinic for evaluation. The clinical examination showed normal body development. BP on the left arm was 203/115 mm Hg, on the right arm - 206/115 mm Hg, normal heart sounds, 76 bpm. A systolic murmur was audible at the parasternal left area. BP on both legs was 140/90 mm Hg. There were no clinically significant abnormalities in other organs and systems. At transthoracic echocardiography we found the signs of a CoA, with a gradient of 80/32 mm Hg, and post-stenotic blood flow in the abdominal aorta. According to the computed tomography angiography signs of CoA in a typical place were confirmed as well as collateral blood flow through the dilated intercostal and mammary arteries. A week after admission to the hospital an operation of resecting the CoA, prosthetics of the arch and descending aorta, and transection of the aortopulmonary ligament was performed. The postoperative period was uneventful, the patient was discharged 10 days after the intervention with the recommendations of continuous administration of metoprolol 100 mg, torasemide 5 mg. At the 3–month follow–up visit the BP was stabilized at 130/80 mm Hg. Conclusions: This clinical case presented a rare isolated type of CoA and demonstrates the importance of qualitative examination of young patients with hypertension, including BP measurement on the lower extremities and transthoracic echocardiography with a compulsory examination of the aorta.