Adult-type Aortic Coarctation with Multiple Cardiovascular Anomalies
2023; Radiological Society of North America; Volume: 307; Issue: 2 Linguagem: Inglês
10.1148/radiol.221882
ISSN1527-1315
Autores Tópico(s)Aortic Disease and Treatment Approaches
ResumoHomeRadiologyVol. 307, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyAdult-type Aortic Coarctation with Multiple Cardiovascular AnomaliesXuehan Hu, Zhidong Yuan Xuehan Hu, Zhidong Yuan Author AffiliationsFrom the Department of Radiology, Peking University Shenzhen Hospital, 1120 Lianhua Rd, Futian District, Shenzhen 518036, China (X.H., Z.Y.); and Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (X.H.).Address correspondence to Z.Y. (email: [email protected]).Xuehan HuZhidong Yuan Published Online:Jan 3 2023https://doi.org/10.1148/radiol.221882MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.An 18-year-old man presented with hypertension of 160/100 mm Hg for 5 years, without abnormal serum laboratory findings. Aortic CT angiography (CTA) showed stenosis of the juxtaductal distal aortic arch (Figure, A, B), with a narrow diameter of 3.5 mm. Abundant collateral pathways formed by means of the posterior intercostal arteries, internal thoracic arteries, and a bronchial artery vascular mass connected with the right subclavian artery and circumflex coronary artery (Figure, A; Movie 1). Moreover, both the left and right coronary arteries originated anomalously from the ascending aorta high above the left aortic sinus of a bicuspid aortic valve (Figure, A). Digital subtraction angiography confirmed the diagnosis of coarctation of the aorta before treatment with balloon angioplasty (Figure, C; Movie 2). The blood pressure immediately returned to nearly normal. The abundant collateral vessels were significantly reduced at 6-month follow-up CTA (Fig S1). In patients with coarctation of the aorta, the prevalence of bicuspid aortic valve is 50%–75% (1), while the anomalous aortic origin of a coronary artery is rare. These anomalies may complicate coronary angiography and aortic valve replacement (2).Images show coarctation of the aorta (CoA) accompanied by multiple cardiovascular anomalies. (A) CT angiogram volume rendering with colored segmentation shows coarctation of the aorta (solid arrow) with abundant collateral pathways by means of the posterior intercostal arteries (green), internal thoracic arteries (purple), and an anastomosis of the bronchial artery and circumflex coronary artery (yellow). A coronary artery anomaly (CAA) (arrowhead) and bicuspid aortic valve (BAV) (dotted arrow) are also depicted. (B) Sagittal CT angiogram and (C) digital subtraction angiogram show the severe stenosis (white arrows on B and C) of the juxtaductal distal aortic arch and abundant dilated collateral pathways (black arrows on C).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie 1: Three hundred sixty-degree spin of advanced three-dimensional volume rendering reconstruction image.Download Original Video (12.4 MB)Get the Flash Player to see this video.Movie 2: Digital subtraction angiograms of before and after balloon angioplasty.Download Original Video (7.3 MB)Disclosures of conflicts of interest: X.H. No relevant relationships. Z.Y. No relevant relationships.AcknowledgmentThe authors thank Dr Min Chen, MD, PhD, from the Department of Radiology, Peking University Shenzhen Hospital for her help in image interpretation and language editing.Supported by the China Postdoctoral Science Foundation (grant 2021M703373) and the Shenzhen High-level Hospital Construction Fund.References1. Michałowska IM, Hryniewiecki T, Kwiatek P, Stokłosa P, Swoboda-Rydz U, Szymański P. Coronary Artery Variants and Anomalies in Patients With Bicuspid Aortic Valve. J Thorac Imaging 2016;31(3):156–162. Crossref, Medline, Google Scholar2. Gentile F, Castiglione V, De Caterina R. Coronary Artery Anomalies. Circulation 2021;144(12):983–996. Crossref, Medline, Google ScholarArticle HistoryReceived: Aug 3 2022Revision requested: Aug 22 2022Revision received: Sept 7 2022Accepted: Sept 12 2022Published online: Jan 03 2023 FiguresReferencesRelatedDetailsRecommended Articles Multimodality Imaging of Transposition of the Great ArteriesRadioGraphics2021Volume: 41Issue: 2pp. 338-360An Interventionalist’s Guide to Hemoptysis in Cystic FibrosisRadioGraphics2018Volume: 38Issue: 2pp. 624-641Imaging Features of Complications after Coronary Interventions and Surgical ProceduresRadioGraphics2021Volume: 41Issue: 3pp. 699-719CT for Evaluation of HemoptysisRadioGraphics2021Volume: 41Issue: 3pp. 742-761International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research PurposesRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 4See More RSNA Education Exhibits Problems With the Pulse of Life: Imaging in Congenital and Hereditary Thoracic Aortic ConditionsDigital Posters2020Advanced Cardiovascular Computed Tomography Imaging in Children with Congenital Variants and Anomalies of the Aortic Arch: From Volume Rendering to 3D Models and 3D PrintingDigital Posters2022State-of-the-art Imaging Of Adult Congenital AortopathiesDigital Posters2021 RSNA Case Collection Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA)RSNA Case Collection2020Middle aortic syndromeRSNA Case Collection2020Leriche syndromeRSNA Case Collection2021 Vol. 307, No. 2 Supplemental MaterialMetrics Altmetric Score PDF download
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