Adult-type Aortic Coarctation with Multiple Cardiovascular Anomalies.

Abstract

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyAdult-type Aortic Coarctation with Multiple Cardiovascular AnomaliesXuehan Hu, Zhidong Yuan Xuehan Hu, Zhidong Yuan Author AffiliationsFrom the Department of Radiology, Peking University Shenzhen Hospital, 1120 Lianhua Rd, Futian District, Shenzhen 518036, China (X.H., Z.Y.); and Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (X.H.).Address correspondence to Z.Y. (email: [email protected]).Xuehan HuZhidong Yuan Published Online:Jan 3 2023https://doi.org/10.1148/radiol.221882MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.An 18-year-old man presented with hypertension of 160/100 mm Hg for 5 years, without abnormal serum laboratory findings. Aortic CT angiography (CTA) showed stenosis of the juxtaductal distal aortic arch (Figure, A, B), with a narrow diameter of 3.5 mm. Abundant collateral pathways formed by means of the posterior intercostal arteries, internal thoracic arteries, and a bronchial artery vascular mass connected with the right subclavian artery and circumflex coronary artery (Figure, A; Movie 1). Moreover, both the left and right coronary arteries originated anomalously from the ascending aorta high above the left aortic sinus of a bicuspid aortic valve (Figure, A). Digital subtraction angiography confirmed the diagnosis of coarctation of the aorta before treatment with balloon angioplasty (Figure, C; Movie 2). The blood pressure immediately returned to nearly normal. The abundant collateral vessels were significantly reduced at 6-month follow-up CTA (Fig S1). In patients with coarctation of the aorta, the prevalence of bicuspid aortic valve is 50%–75% (1), while the anomalous aortic origin of a coronary artery is rare. These anomalies may complicate coronary angiography and aortic valve replacement (2).Images show coarctation of the aorta (CoA) accompanied by multiple cardiovascular anomalies. (A) CT angiogram volume rendering with colored segmentation shows coarctation of the aorta (solid arrow) with abundant collateral pathways by means of the posterior intercostal arteries (green), internal thoracic arteries (purple), and an anastomosis of the bronchial artery and circumflex coronary artery (yellow). A coronary artery anomaly (CAA) (arrowhead) and bicuspid aortic valve (BAV) (dotted arrow) are also depicted. (B) Sagittal CT angiogram and (C) digital subtraction angiogram show the severe stenosis (white arrows on B and C) of the juxtaductal distal aortic arch and abundant dilated collateral pathways (black arrows on C).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie 1: Three hundred sixty-degree spin of advanced three-dimensional volume rendering reconstruction image.Download Original Video (12.4 MB)Get the Flash Player to see this video.Movie 2: Digital subtraction angiograms of before and after balloon angioplasty.Download Original Video (7.3 MB)Disclosures of conflicts of interest: X.H. No relevant relationships. Z.Y. No relevant relationships.AcknowledgmentThe authors thank Dr Min Chen, MD, PhD, from the Department of Radiology, Peking University Shenzhen Hospital for her help in image interpretation and language editing.Supported by the China Postdoctoral Science Foundation (grant 2021M703373) and the Shenzhen High-level Hospital Construction Fund.