Abstract P186: Reversion of Severe Cardiac and Renal Dysfunction With Surgical Correction of Atypical Aortic Coarctation in Adult Patient: Case Report

Abstract

Background: Heart and renal dysfunction are the most frequent complications of arterial hypertension (AH). Secondary causes of AH can lead to severe organ damage, potentially reversible after treatment. Objective: To report a rare cause of AH in adult, atypical aortic coarctation, where surgical correction promoted reversion of organ damage. Report: Woman, 55 years-old, history of AH for 10 years, worsening of blood pressure (BP) control for the last 10 months, and progressive dyspnea on exertion, reaching dyspnea at rest. Admission: BP=260x110mmHg and acute pulmonary edema. Improvement of clinical condition with intensive measures, and after, the patient showed differences in BP between left (120x100mmHg) and right upper arm (180x110mmHg), systolic murmur on mitral region, absence of pulse in lower limbs. Exams: Serum creatinine (Cr) = 1,7mg/dL; EKG: left chamber overload; Echocardiogram: table; Magnetic resonance angiography of the aorta: severe stenosis of the aortic arch (13.6mm in its largest diameter). Patient was submitted to a bypass (Dacron #18 tube) from the ascending to the descending segment of the aorta. In the post-operatory period the patient improved renal function (Cr 1.0mg/dl) and controlled BP under use of 1 drug. One month after surgery, patient maintained BP adequately controlled significantly improved echocardiographic parameters (table). In long-term follow-up, patient remained asymptomatic with BP=124x72mmHg, and normal renal and cardiac function, under use of 3 antihypertensive drugs. Conclusion: Atypical aortic coarctation at adult age can lead to severe cardiac and renal impairment, which is reversible after surgical correction.