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(Circulation. 1999;100:e51-e52.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Delayed Diagnosis of Aortic Coarctation

The Third Medical Visit

Guy Amah, MD; Paul Milliez, MD; Jacques Blacher, MD; Xavier Girerd, MD, PhD; Jean-Paul Couetil, MD; Michel E. Safar, MD

From the Department of Internal Medicine (G.A., P.M., J.B., X.G., M.E.S.) and the Department of Cardiovascular and Thoracic Surgery (J.-P.C.), Broussais Hospital, Paris, France.

	Introduction

 
Ablack male native of Côte d'Ivoire (West Africa) met a doctor for the first time at age 3 because of an inability to walk. A traditional African medical practitioner left the parents with little hope. Nevertheless, the patient was finally able to walk but continued to suffer an inability to run.

His second meeting with a doctor was at age 30 in the intensive care unit of Abidjan Hospital, Côte d'Ivoire, because of a stroke, with left hemiplegia and coma, associated with high blood pressure. He was discharged from the hospital 15 days later on an antihypertensive drug. The neurological recovery was complete 1 year later.

During a checkup after 16 years of no medical examinations, French immigration physicians found high blood pressure and heart murmur, leading to the transfer of the patient to our Cardiovascular Department. This was his third medical visit.

Because of high blood pressure, asymmetry of blood pressure between the 2 arms, systolic heart murmur, increased carotid pulses, and decreased femoral pulses, aortic coarctation was suspected. MRI angiography (Figure 1) and spiral CT (Figure 2) confirmed the diagnosis. A left subclavian artery aneurysm was also found, which explained the initial chest radiographic image (Figure 3). Additional supra-aortic vascular abnormalities were found, along with a collector trunk replacing the innominate artery and common left carotid artery (Figure 2).

View larger version (133K): [in this window] [in a new window]   Figure 1. Cervicothoracic 3D gadolinium-enhanced MRI angiography. A, Very narrowed coarctation of aorta. B, Left subclavian artery aneurysm. C, Important collateral circulation involving intercostal and . . . [Full Text of this Article]

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