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An incidental finding of a bicuspid aortic valve and pseudocoarctation of the descending aorta in a patient presenting with an acute coronary syndrome: a case report.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-5.EH

Abstract

Background

Aortic pseudocoarctation (PsCoA) is an elongation of the supra-isthmic aorta with kinking and low-grade narrowing. Consequently, no collateral circulation is found. It is frequently associated with other congenital heart anomalies, such as bicuspid aortic valve (BAV).

Case summary

We report the case of 60-year-old patient who presented to the ED with acute chest pain. Physical examination was remarkable for an elevated blood pressure (BP) and the presence of a systolic murmur on the left lower sternal border. An acute coronary syndrome was suspected and the patient underwent urgent coronary angiogram which showed an occluded obtuse marginal artery. Additionally, the presence of an aortic anomaly was noted during the aortography, and additional work-up, including a thoracic computed tomography angiography and transoesophageal echocardiography, revealed a BAV and a PsCoA of the descending aorta. The patient was discharged after optimizing BP control with oral medication and periodical follow-up was arranged.

Discussion

Aortic PsCoA may mimic true coarctation (CoA), but the absence of a haemodynamically significant descending aortic narrowing and of the typical clinical findings associated with aortic CoA, distinguishes both entities. Treatment is therefore conservative and based on the control of cardiovascular risk factors and in particular of arterial hypertension. Work-up should include imaging of the entire aorta and the search for associated congenital cardiac anomalies, which, if present, should be managed in consequence.

Authors+Show Affiliations

Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland.Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland.Department of Cardiology, University and Hospital of Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617494

Citation

Vivekanantham, Hari, et al. "An Incidental Finding of a Bicuspid Aortic Valve and Pseudocoarctation of the Descending Aorta in a Patient Presenting With an Acute Coronary Syndrome: a Case Report." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-5.
Vivekanantham H, Cook S, Stauffer JC. An incidental finding of a bicuspid aortic valve and pseudocoarctation of the descending aorta in a patient presenting with an acute coronary syndrome: a case report. Eur Heart J Case Rep. 2020;4(3):1-5.
Vivekanantham, H., Cook, S., & Stauffer, J. C. (2020). An incidental finding of a bicuspid aortic valve and pseudocoarctation of the descending aorta in a patient presenting with an acute coronary syndrome: a case report. European Heart Journal. Case Reports, 4(3), 1-5. https://doi.org/10.1093/ehjcr/ytaa105
Vivekanantham H, Cook S, Stauffer JC. An Incidental Finding of a Bicuspid Aortic Valve and Pseudocoarctation of the Descending Aorta in a Patient Presenting With an Acute Coronary Syndrome: a Case Report. Eur Heart J Case Rep. 2020;4(3):1-5. PubMed PMID: 32617494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An incidental finding of a bicuspid aortic valve and pseudocoarctation of the descending aorta in a patient presenting with an acute coronary syndrome: a case report. AU - Vivekanantham,Hari, AU - Cook,Stéphane, AU - Stauffer,Jean-Christophe, Y1 - 2020/05/15/ PY - 2020/01/15/received PY - 2020/02/12/revised PY - 2020/04/09/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Acute coronary syndrome KW - Aortic coarctation KW - Aortic pseudocoarctation KW - Bicuspid aortic valve KW - Case report KW - Secondary hypertension SP - 1 EP - 5 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Aortic pseudocoarctation (PsCoA) is an elongation of the supra-isthmic aorta with kinking and low-grade narrowing. Consequently, no collateral circulation is found. It is frequently associated with other congenital heart anomalies, such as bicuspid aortic valve (BAV). Case summary: We report the case of 60-year-old patient who presented to the ED with acute chest pain. Physical examination was remarkable for an elevated blood pressure (BP) and the presence of a systolic murmur on the left lower sternal border. An acute coronary syndrome was suspected and the patient underwent urgent coronary angiogram which showed an occluded obtuse marginal artery. Additionally, the presence of an aortic anomaly was noted during the aortography, and additional work-up, including a thoracic computed tomography angiography and transoesophageal echocardiography, revealed a BAV and a PsCoA of the descending aorta. The patient was discharged after optimizing BP control with oral medication and periodical follow-up was arranged. Discussion: Aortic PsCoA may mimic true coarctation (CoA), but the absence of a haemodynamically significant descending aortic narrowing and of the typical clinical findings associated with aortic CoA, distinguishes both entities. Treatment is therefore conservative and based on the control of cardiovascular risk factors and in particular of arterial hypertension. Work-up should include imaging of the entire aorta and the search for associated congenital cardiac anomalies, which, if present, should be managed in consequence. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617494/An_incidental_finding_of_a_bicuspid_aortic_valve_and_pseudocoarctation_of_the_descending_aorta_in_a_patient_presenting_with_an_acute_coronary_syndrome:_a_case_report DB - PRIME DP - Unbound Medicine ER -
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