Aortic coarctation is a congenital vascular lesion typically diagnosed in early life, accounting for 5 to 10% of all congenital cardiovascular malformations [1] but may go undetected well until adulthood. Most commonly, coarctation diagnosed at ages beyond childhood was discovered in asymptomatic patients in whom a routine physical examination disclosed upper limb hypertension with diminished or absent femoral pulses [2]. Patients with aortic coarctation rarely survive to old age for their first diagnosis [3]. Most untreated patients with coarctation of the aorta will die before 50 years of age [3]. Death in these patients is usually due to heart failure, coronary artery disease, aortic rupture/dissection, concomitant aortic valve disease, infective endarteritis/endocarditis, or cerebral hemorrhage [3, 7]. There are few reports of patients first diagnosed with uncorrected aortic coarctation at very late age [4]-[6], and there is no consensus on how to manage them. In this report, we present the case of a 72-year-old woman first diagnosed with severe aortic coarctation. Our patient was relatively asymptomatic until she presented with fatigue and exertional dyspnea in her seventh decade of life.
Treatment of aortic coarctation consists of aggressive hypertension therapy, endocarditis prophylaxis and corrective treatment for coarctation with a high gradient. Aortic obstruction may be relieved by surgery or by transcatheter techniques. In the past, surgery has been used exclusively. However, over the last 20 years, balloon angioplasty, recently associated with stenting, is a widely accepted therapeutic procedure for aortic coarctation and is recommended as the therapy of choice in experienced centers [8, 9]. Despite successful repair of aortic coarctation, recurrent hypertension is common during long-term follow up.
The reported prevalence of late hypertension depends on the diagnostic criteria used and on the duration of follow up, ranging from 30% [10] to 75% [11]. Because there are only a few cases of elderly patients with uncorrected aortic coarctation, management strategies in these patients are controversial. The beneficial effect of intervention -whether surgical or transcatheter- in terms of diminished mortality in very old patients is still questionable, which makes conservative management with antihypertensive drug therapy an acceptable treatment option in such patients.