Long Segment Coarctation of the Abdominal Aorta in a 12-Year-Old Patient: A Case Report

Coarctation (CoA) of the abdominal aorta, better classified as midaortic syndrome (MAS), represents a rare and complex vascular anomaly that results in narrowing of the descending distal thoracic and/or abdominal aorta. Clinical presentation in pediatric patients is complex and sometimes undetected; consequently, prognosis is grim, especially in preterm infants. Most common indications are hypertension, which mostly remains unresolved with high doses and/or combinations of antihypertensive medications, claudication of lower limbs and/or feeble or absent femoral pulses. Surgery appears to be the only preferred choice of treatment in pediatric patients for lifelong disease management. In this case presentation, a 12-year-old male child exhibited severe headache and myalgia over the past six months. Physical examination revealed resting blood pressure of 146/80 mmHg despite being on three antihypertensive medications. A Doppler test and CT angiogram confirmed the presence of long-segment coarctation of the distal thoracic and proximal abdominal aorta. Other reports, such as blood tests, ECG and 2D echocardiogram, were normal. The patient thereafter underwent successful thoraco-abdominal aorto-aortic bypass employing a Dacron tube graft (14 mm x 60 cm), which resulted in an immediate drop in the brachio-femoral gradient (radial-160/85 mmHg, femoral-120/80 mmHg, mean gradient 16.6 mmHg). The patient was discharged on postoperative day (POD) 12, and the antihypertensive medications were readjusted. In subsequent follow-up periods for up to two years, all antihypertensive medications were stopped. At five years POD, the blood pressure rebounded to 170/94 mmHg. The CT angiograms post-surgery at one-month and five-year POD were normal. The patient did not report any adverse event (AE) and remained asymptomatic for five years.