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A severe coarctation of the aorta incidentally diagnosed during cardiac catheterization of a 40-year-old male patient presenting acute coronary syndrome / Akut koroner sendrom nedeni ile basvuran 40 yasinda erkek hastada kardiyak kateterizasyon sirasinda tani konulan ciddi aort koarktasyonu.

Coarctation is defined as a narrowing of the lumen of the aorta that obstructs flow. Typically, it is located at the insertion of the ductus or ligamentum arteriosum. It accounts for 5% to 10% of congenital heart disease and occurs more frequently in Caucasian and males. The disorder is typically diagnosed in childhood but may go undetected well into adulthood. Most patients develop persistent systemic hypertension and are at risk for premature coronary artery disease.

A 40-year-old man was referred to our hospital with the diagnosis of non-ST elevation myocardial infarction. There was no any cardiovascular risk factors except for systemic hypertension. A systolic ejection murmur at the left upper sternal border and upper extremity hypertension in conjunction with diminished femoral pulsations was found in cardiovascular physical examination. Electrocardiogram showed lateral ischemia. Coronary angiography was planned through the right femoral artery. However, the guidewire did not move forward due to aortic obstruction (Fig. 1, Video 1,2. See corresponding video images at www.anakarder.com). Therefore, coronary angiography was performed through the left brachial artery. Left anterior descending artery and left circumflex artery lesions were found on coronary angiography (Fig. 2). Arcus aortography and computed tomography-angiography showed coarctation of the aorta distal to the left subclavian artery origin (Fig. 3). The patient was referred to the department of cardiovascular surgery for the surgical management of coarctation of aorta and coronary artery disease.

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References

(1.) Grech V. Diagnostic and surgical trends, and epidemiology of coarctation of the aorta in a population-based study. Int J Cardiol 1999; 68: 197-202.

(2.) Jenkins NP, Ward C. Coarctation of the aorta: natural history and outcome after surgical treatment. QJM 1999; 92: 365-71.

(3.) O'Connor AR, Moody AR, Ludman CN. Images in cardiology. Aortic coarctation diagnosed by magnetic resonance angiography. Heart 1999; 81: 671.

(4.) Rothman A. Coarctation of the aorta. Curr Probl Pediatr 1998; 28: 33-60.

Address for Correspondence/Yazisma Adresi: Serkan Topaloglu, Akpinar mah. 23. cad. 10/22 Dikmen, Ankara, Turkey Phone: +90 312 306 11 33 Fax: +90 312 417 53 15 E-mail: topaloglus@yahoo.com

Asuman Yesilay, Serkan Topaloglu, Dursun Aras, Kazim Baser,

Halil Lutfi Kisacik, Sule Korkmaz

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital

Ankara, Turkey
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Title Annotation:E-page Original Images / E-sayfa Orijinal Goruntuler
Author:Yesilay, Asuman; Topaloglu, Serkan; Aras, Dursun; Baser, Kazim; Kisacik, Halil Lutfi; Korkmaz, Sule
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Clinical report
Geographic Code:7TURK
Date:Dec 1, 2007
Words:374
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