Supersized Atheroma Causing Acquired Coarctation of Aorta Leading to Heart Failure

Sajin Karakattu,Kamesh Sivagnanam,Ghulam Murtaza,Jeffrey W Schoondyke ,Dheeraj Sharma ,Timir K Paul

doi:10.1177/2324709616689477

Sajin Karakattu, Kamesh Sivagnanam + Show 4 more

Open Access

https://doi.org/10.1177/2324709616689477

Copy DOI

Abstract

Calcified atheromatous aortic lesion causing significant narrowing of the aorta is an uncommon clinical entity. This calcified atheroma leads to obstruction of the lumen of the aorta simulating acquired coarctation of aorta causing impaired perfusion of lower limbs, visceral ischemia, and hypertension. We report a case of 58-year-old patient who presented with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, 25-lb weight gain, lower extremity edema, and chest pain. Extensive workup including computed tomography and magnetic resonance imaging revealed a large calcific mass in the aortic arch causing his presenting symptoms. After surgical correction his symptoms resolved. Any patient presenting with heart failure symptoms in the setting of uncontrolled renovascular hypertension, intermittent claudication symptoms, or visceral ischemia with normal ejection fraction but moderate to severe left ventricular hypertrophy should be in high suspicion for acquired coarctation of aorta. The routine thorough examination of pulses in bilateral upper and lower extremities in all hypertensive patients is a very simple and useful clinical tool to diagnose acquired aortic coarctation.

Highlights

Acquired atheromatous coarctation of aortic arch is an uncommon finding with an estimated prevalence between 0.6% and 1.8%
Localized obstruction in a suprarenal aorta of normal diameter caused by an eccentric, heavily calcified lesion is uncommon. This heavily calcified plaque expands into the lumen and can cause significant narrowing, which may lead to malperfusion of the lower limbs, cause visceral ischemia distal to obstruction, heart failure due to increased afterload, and hypertension due to renal ischemia and/or aortic luminal obstruction.[1]
Urgent computed tomography (CT) chest angiogram showed focal globular calcification near the distal arch of aorta (Figure 3) causing near complete occlusion leading to acquired aortic coarctation

Summary

Introduction

Acquired atheromatous coarctation of aortic arch is an uncommon finding with an estimated prevalence between 0.6% and 1.8%. He reported that he has been having progressive difficulty in breathing, worsening lower extremity edema, orthopnea, dry cough, and 25-lb weight gain in 2 weeks His blood pressure at presentation was 172/64 mm Hg, pulse rate 86 beats per minute, respiratory rate 18 breaths/min, and oxygen saturation 92% on 2 L of oxygen. Urgent computed tomography (CT) chest angiogram showed focal globular calcification near the distal arch of aorta (Figure 3) causing near complete occlusion leading to acquired aortic coarctation. The patient was found to have low ankle brachial index performed due to diminished pulses in lower extremities He underwent ascending aortic to proximal descending aorta bypass with a 16 mm Hemashield graft approached through median sternotomy with left posterior lateral thoracotomy. On 3 months follow-up with cardiology office, he reported improved exercise tolerance with markedly improved shortness of breath and claudication symptoms

Findings

Discussion

Conclusion