Unraveling Uncontrolled Hypertension in a Young Female with Atypical Aortic Coarctation: A Case Review.

Abstract

Background: Atypical aortic coarctation can lead to significant complications such as uncontrolled hypertension, particularly in young patients. This case highlights the importance of thorough evaluation and timely intervention.

Case Presentation: A 25-year-old female, non-diabetic, presented with uncontrolled hypertension despite a regimen of multiple antihypertensive medications. On examination, she had a blood pressure of 160/90 mmHg in both upper limbs, feeble bilateral femoral pulses, and absent distal pulses. Baseline investigations, including echocardiography, showed an ejection fraction (EF) of 62% with a tri-leaflet aortic valve. Notably, imaging revealed narrowing of the distal descending thoracic aorta with a pressure gradient of 49 mmHg, severe concentric left ventricular hypertrophy (LVH), and grade II diastolic dysfunction.

Results: The patient successfully underwent percutaneous endovascular stenting with a covered stent (Aortic Be Graft, 14x49 mm) for aortic coarctation. Post-procedural hemostasis was achieved after addressing significant oozing. A follow-up aortogram indicated total occlusion of the common and superficial femoral arteries, which was treated with percutaneous transluminal angioplasty (PTA). Discharged on the fourth postoperative day, the patient was prescribed dual antiplatelet therapy (aspirin and clopidogrel, 75 mg each). At one-week follow-up, she reported no complications and maintained stable blood pressure (100/60 mmHg to 120/80 mmHg) without antihypertensive medications. A repeat echocardiogram confirmed a zero-pressure gradient across the descending aorta, demonstrating the intervention's success. The patient expressed satisfaction with her treatment and recognized the importance of medication adherence for long-term health.

Conclusion: This case highlights the importance of early diagnosis and appropriate intervention in young patients with uncontrolled hypertension. Atypical coarctation of the aorta should be considered a potential etiology, and percutaneous endovascular stenting is a safe and effective treatment option.