Asian Cardiovasc Thorac Ann 2007;15:270
© 2007 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Coarctation of Aorta with Intercostal Artery Aneurysm and Patent Ductus Arteriosus
Manoj K Rohit, DM,
Shyam K Thingam, MCh1,
Sridhar Gopal, DM,
Hariram Vuppaladadhiam, DM,
Anil Grover, DM
Department of Cardiology
1 Department of Cardiothoracic and Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
For reprint information contact: Manoj K Rohit, DM Tel: 91 172 275 6513 Fax: 91 172 274 4401 Email: manoj_786{at}hotmail.com, Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
A 12-year-old boy was detected to have weak lower limb pulses with hypertension; supine forearm and lower limb blood pressures (BP) of 160/100 and 120/80 mmHg respectively. There was a grade III continuous murmur in the left second intercostal space and interscapular region. Echocardiography showed coarctation of aorta (CoA) with a patent ductus arteriosus (PDA). Cardiac catheterization confirmed the diagnosis of CoA (peak gradient of 50 mmHg) and a 1.6 mm PDA. An aneurysm was seen below the coarcted segment with a feeding vessel from descending thoracic aorta (figures 1
and 2).
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Figure 1. Aortic arch angiogram showing coarctation of aorta with intercostal artery aneurysm and a small PDA.
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Operative findings revealed a 24 x 26 mm sacular aneurysm arising from the intercostal artery along with CoA and PDA. He underwent en block resection and repair of the CoA and intercostal artery aneurysm and ligation of PDA.
Aneurysm formation in CoA is rare, with its incidence rising with age.1 Serious bleeding and sudden death associated with these aneurysms2,3 can be avoided by early diagnosis and treatment,4 resulting in improvement of impaired left ventricular function and normalization of blood pressure.
REFERENCE
- Braimbridge MV, Yen A: Coarctation in the elderly. Circulation 1965;31:209–218.[Abstract/Free Full Text]
- Heifetz SA, Zeichner MB, Minkowitz S: Sudden death from ruptured intercostal artery aneurysm. A late complication of thoracotomy. Arch Surg 1975;110:1253–1254[Abstract/Free Full Text]
- Chanarin N, Lamb RK, Gray HH: Late rupture of superior intercostal artery following repair of aortic Coarctation. J Cardiovasc Surg 1991;32:132–134[Medline]
- Kelsay DE, Ribeiro P. Aortic Coarctation with two intercostal aneurysms, appearing radiographically as a subclavian aneurysm. A case report. Angiology 1996;47:103–106.[Medline]
