Therapy refractory hypertension in adults aortic

Authors: M E W Hemels E S Hoendermis J P van Melle P G Pieper

Publish Date: 2011/02/11

Volume: 19, Issue: 3, Pages: 107-111

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Abstract

In patients with unexplained hypertension especially in combination with a cardiac murmur the presence of an aortic coarctation should always be ruled out given the high morbidity and mortality However particularly patients with an isolated coarctation often remain asymptomatic for years and the defect may be unnoticed even until the fifth or sixth decade of life In the present article we describe two patients with late detected coarctation to illustrate the clinical consequences diagnostic clues for earlier detection and current therapeutic options to achieve optimal treatment The key sign of an aortic coarctation a difference in arterial blood pressure measured between the upper and lower extremities should always be examined followed by echocardiography We conclude that even in case of a late detected severe coarctation surgical or percutaneous repair has proven to be feasible and substantially effective improving quality of life and lowering the risk of further hypertensionassociated problemsCoarctation of the aorta is a localised stenosis of the aorta most commonly located just distal to the origin of the left subclavian artery and closely related to the attachment of the ductus arteriosus with the aorta It accounts for 5 to 9 of all congenital cardiovascular defects 1 Frequently associated congenital defects are a bicuspid aortic valve valvular and subvalvular aortic stenosis mitral stenosis ventricular septal defect and persistent ductus arteriosus 2 Coarctation causes an increased afterload for the left ventricle resulting in an increased systolic pressure in the left ventricle and upper part of the body Treatment of aortic coarctation can be performed surgically or percutaneously Even after successful correction hypertension often persists due to abnormal vascular physiology Uncorrected or unnoticed coarctation results in a high morbidity and mortality mainly due to hypertensionassociated problems 3 However patients with isolated coarctation coarctation without additional congenital defects often remain asymptomatic for years and the defect may be unnoticed even until the fifth or sixth decade of life Although a late detected coarctation almost always includes irreversible cardiovascular damage adequate treatment can result in a substantial improvement in both quality of life and prognosis 4 5 6 7 In the present article we describe two patients with late detected coarctation to illustrate the clinical consequences diagnostic clues for earlier detection and current therapeutic options to achieve optimal treatment in these patients

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