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doi:10.1093/ehjci/jes006 Online publish-ahead-of-print 26 January 2012
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Multiple regions of coarctation of the aorta associated with bicuspid aortic valve in a 74-year-old female Hidekazu Tanaka*, Kensuke Matsumoto, Hiroya Kawai, and Ken-ichi Hirata Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
* Corresponding author. Tel: +81 78 382 5846; fax: +81 78 382 5859, Email:
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A 74-year-old asymptomatic female was referred to our hospital for examination of systolic ejection murmur. Transthoracic echocardiography showed mild aortic stenosis with a mean pressure gradient of 18 mmHg and an aortic valve area of 1.50 cm2 determined by continuity equation. Twodimensional and real-time three-dimensional transoesophageal echocardiography clearly showed a bicuspid aortic valve and mild calcification of the aortic leaflet at the 6 o’clock position (Figure 1A and B). The computed tomography scan with three-dimensional reconstruction revealed three twisted segments of the descending aorta, which suggested the presence of multiple regions of coarctation of the aorta (Figure 1C and D). The first segment was located just below the left subclavian artery, and the proximal region was Figure 1 Two-dimensional (A) and real-time three-dimensional transoesophageal enlarged with a fusiform shape and maximum (B) echocardiography clearly showed symmetrical aortic leaflets without the raphe, diameter of 40 mm. The second segment was with mild calcification at the 6 o’clock position of the aortic leaflet. (C and D) The in the middle of the descending aorta and computed tomography scan with three-dimensional reconstruction revealed three segments of coarctaion of the aorta one just below the left subclavian artery the third segment was just below the renal (arrow), the second in the middle of the descending aorta (dotted arrow), and the artery. The catheter-determined pressure third just below the renal artery (double arrow). gradients were 5, 7, and 48 mmHg, respectively. No collateral vessels or visible notching of the ribs were observed. Furthermore, the blood pressures in the upper and lower extremity were 148/77 and 130/ 76 mmHg, respectively. The patient has been followed up by watchful waiting because she refused to undergo surgery. Bicuspid aortic valve can be complicated with various aortic abnormalities. Coarctation of the aorta has been observed in 7% of bicuspid aortic valve cases and is usually corrected early in life. Since long-term survival is exceptional for patients with untreated aortic coarctation, we present here a case report of late diagnosis of aortic coarctation in a 74-year-old asymptomatic female, which also underscores the utility of transoesophageal echocardiography and computed tomography scan with three-dimensional reconstruction for characterizing the morphology and determining the diagnosis of coarctation of aorta associated with bicuspid aortic valve.
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