Mid-abdominal Coarctation Exacerbated by Pre-eclampsia: A Case Report of Thoracoabdominal Reconstruction in a Woman who Suffered Hypertension Induced Premature Childbirth

Abstract

This is a case report of a 23-year-old woman diagnosed with coarctation of the mid-abdominal aorta. She was on three anti-hypertensive medications with poorly controlled hypertension (HTN) when she developed pre-eclampsia, resulting in the premature birth of her 28-week-old baby. After childbirth, she continued to have uncontrolled HTN, symptoms of mesenteric ischemia and lower extremity claudication. A computed tomography (CT) angiogram showed approximately 50% focal narrowing of the aorta at the origin of the renal arteries, extending distally approximately 4 cm in length, near occlusion at the origin of the celiac artery with multiple collateral vessels including a patent arc of Buehler, severe stenosis of the superior mesenteric artery (SMA), and bilateral focal stenosis of the renal ostium. She underwent thoracoabdominal aortic repair with 14 mm Dacron end-to-side tube graft placement extending from the descending thoracic to the infrarenal aorta. A 12 mm x 7 mm bifurcated graft was used to complete the aorto-common hepatic artery and aorto-SMA bypasses. A third graft limb was sewn from the aortic graft to revascularize the left renal artery. Postoperatively, blood pressure was stringently monitored with goal pressures of <140/90. On postoperative day 10, she was discharged home with stable renal function and acceptable blood pressures. At one year follow up, her hypertension has completely resolved with systolic ranges from 120 s to 140 s and she has stopped taking her blood pressure medications. Her mesenteric ischemic and claudication symptoms have also resolved. Follow up CT angiogram at one year confirms patency of the aorto-aorto graft, aorto-hepatic, aorto-SMA, and aorto-left renal bypasses. This is an interesting patient with mid-abdominal coarctation syndrome whose clinical severity exacerbated with the presence of pre-eclampsia. Subsequent thoracoabdominal reconstruction appears to have been an excellent option for her.