A 28- year- old woman was admitted because of uncontrolled hypertension following delivery. Aortography showed severe coarctation of the aortic arch, and a large- sized aneurysm that was located in the aortic arch distal to the left common carotid artery. The patient was scheduled for surgery. The coarctation was removed and the aortic arch was replaced with a 28-mm Dacron tube, and the left subclavian artery was reimplanted to the Dacron tube. The patient tolerated the procedure well and was discharged from hospital 15 days later.

Objective- The aim of this study was to evaluate the use of endovascular intervention in managing native and recurrent aortic coarctation in adult patients. Methods-Balloon angioplasty was undertaken transfemorally in 16 patients (mean age 18.3 ± 4 years old) with arterial hypertension in 12 native and 4 recurrent aortic coarctations. Systolic pressure gradient measurements were taken peri-interventionally and in the course of follow-up during conventional angiography and transesophageal echocardiography. The average diameters of the balloon catheters used ranged from 15 to 20 mm.Result-lmmiediately after aortic angioplasty, the peak systolic pressure gradient decreased from 61 mmHg ± 5.4 to 7.6 mmHg ± 2.2 across the coarctation (P < 0.001). One patient With recoarctation had an unsuccessful immediate result. Restenosis occurred in two patients, who subsequently underWent repeat dilation with successful results. Transesophageal echocardiography was repeated post-procedure and at 6 months post-intervention. One patient developed a small aneurysm at the site of dilation. In the course of follow-up, no other major or minor complications were observed.Conclusion- Endovascular intervention appears to be a safe and effective alternative to surgery for the treatment of native and recurrent aortic coarctation in most adult patients with a low rate of complications

Objective- We aimed to evaluate the accuracy of Doppler echocardiography indices in patients with significant recoarctation of the aorta (ReCoA).Methods- Thirty-nine consecutive patients (11 females) post-surgical repair of aortic coarctation were included in the study. All the patients underwent complete Doppler echocardiography and clinical evaluation and peak systolic instantaneous pressure gradient (PPG), mean pressure gradient, velocity time integral (VTI) in the descending thoracic aorta, acceleration time (AT), ejection time (ET), and AT/ET of the coarctation repair site were measured. All the patients underwent CT angiography; and in case of significant ReCoA, cardiac catheterization was done.Results- Measured values of ET, AT, AT/ET, and VTI at the repair site and VTI in the descending thoracic aorta were significantly greater in the patients with ReCoA. The average difference between the echocardiographic and angiographic systolic PPG was 16 mmHg. The presence of Doppler PPG greater than 35 mmHg, VTI in the descending thoracic aorta more than 40cm, and AT at the repair site of more than 135 msec had high sensitivity and specificity for the diagnosis of significant ReCoA. Five (0.42) patients with recoarctation had significant hypertension; compared to 7 (0.26) patients without recoarctation (P-value =0.32). Conclusion- After coarctation repair, Doppler PPG should be interpreted with caution but considering other Doppler indices, Doppler echocardiography is a practical and accurate screening method for an evaluation of significant ReCoA, with a low threshold for invasive of aorta investigation if the Doppler PPG in the descending aorta exceeds 35mmHg.

Coarctation of the abdominal aorta is an extremely rare vascular defect in which congenital or acquired etiologies have been described. This case concerns a 30-year-old pregnant woman with 15-years history of uncontrolled hypertension and lower limb claudication presented with worsened hypertension during her first pregnancy. Magnetic resonance angiography study of aorta revealed a stenosis in abdominal aorta about 12mm from the origin of celiac axis accompanied by left sided aortic arch and right aberrant subclavian artery. This case highlights the importance of a throughout physical examination in patients presented with hypertension and it emphasizes considering the coarctation of the abdominal aorta during the diagnostic workup of hypertension, especially in young patients. In such cases magnetic resonance angiography of the aorta is a useful tool to reach a definitive diagnosis especially in pregnant women. Also to our knowledge, this patient is the first one found to have aortic arch malformation combined with an abdominal coarctation.

Background: Coarctation of the aorta (CoA) is a congenital heart defect. Due to the narrowing of the descending aorta, blood flow mainly reduces after the stenosis, and CoA can occur at any region in the thoracic and abdominal aorta. Cardiac surgeons and cardiologists are familiar with postoperative complications of CoA,however, there are also some other complications that have not been reported to date. Case Presentation: The present study investigated three cases of CoA undergoing reconstructive surgery. Nevertheless, a couple of days after the surgery, they manifested symptoms suspected of cerebral infarction. Ischemic infarction was observed after performing brain computed tomography. Additionally, we discuss possible pathophysiology and reasons that can lead to this problem. Conclusions: In this case report, we presented three cases of CoA patients who underwent reconstructive surgery and manifested cerebral infarction as an adverse effect of the reconstructive surgery.

Background: Goldenhar syndrome or oculo-auriculovertebral dysplasia is present in 1/3500 to 1/25000 live births. The most recognizable feature of this syndrome is hemifacial microsomia. It may be associated with several other craniofacial abnormalities and congenial heart diseases (CHD). Ventricular septal defect and tetralogy of Fallot have been reported as the most common CHD in these patients. However, to date, there is no report of persistent fifth aortic arch and severe coarctation in these patients. This is the first report of a 7-year-old boy with Goldenhar syndrome and persistent fifth aortic arch associated with aortic arch tortuosity and severe coarctation in the persistent fifth arch.Case presentation: The patient was a 7-year-old boy, born to a consanguineous parent as a twin pregnancy, after 7 years of infertility. On general appearance, hemifacial microsomia, bilateral dermolipoma of the eyes, deformity of both ears associated with skin tags were apparent. On cardiac examination, pulses were normal in the upper extremities, but were very weak in the lower extremities. A grade 3/6 ejection systolic murmur was heard at upper left sternal border with wide radiation to the back. Renal bruit was heard on the back. On CXR, the left upper border of the cardiac silhouette was almost absent due to the aortic arch abnormality. Aortic angiography showed common origin of all four brachiocephalic branches from the main fouth arch and a torotous, hypoplastic persistent fifth aortic arch with severe coarctation. The patient was referred to pediatric cardiac surgeon for aortic repairment.Conclusion: This is the first report of persistent fifth aortic arch and severe coarctation in a 7-year-old male patient with Goldenhar syndrome. Persistent fifth aortic arch is a rare abnormality of aortic arch with an unkown incidence.Persistent fifth aortic arch may be asymptomatic or may present itself as coarctation.

Abdominal aortic coarctation is an extremely rare vascular pathology. Its etiology can be congenital or acquired. Here we present a case of acquired infrarenal abdominal coarctation in a 66-year-old woman who complained of low back and legs pain. She had no signs of resting lower limb ischemia, with diminished distal pulses and normal blood pressure in upper and lower extremities. Magnetic resonance angiography of abdominal aorta, iliac and femoral arteries revealed local stenosis of abdominal aorta below the renal arteries (80% of luminal diameter). The length of coarctation was 3 cm. The patient was scheduled for percutaneous aortoplasty and stent implantation. Nintinol self-expandable stent was implanted. At 9 months clinical follow up no signs or symptoms of stenosis or diminished blood flow in lower extremities were found. Self-expandable stent is effective, easy to implant, and has good adaptation to the wall of aorta and can be considered in such cases successfully.

The patient was a 19 year-old woman with the diagnosis of resistant hypertension, although she was under treatment of three classes of anti-hypertensive drugs (beta blocker, angiotensin receptor blocker, diuretic) for more than one year. In physical examination there was only a significant difference between the systolic blood pressure of upper and lower extremities (200 vs.120 mmHg), without any other remarkable finding. Three different imaging modalities (echocardiography (Figure 1), CT angiography (Figure 2), conventional aortography (Figure 3) confirmed the aortic coarctation at 30 mm after left subclavian artery origin, with the 3.5-4 mm diameter of the narrowest segment. She underwent implantation of a self-expanding aortic stent and therefore the systolic pressure gradient decreased from 90 to 15 mmHg. After three months, her blood pressure was stable on 110/80 mmHg, while she received only metoprolol 25 mg twice daily and follow-up echocardiography showed 15-20 mmHg pressure gradient through the stent.