Stenting of complex case of coarctation of aorta with a large coronary –aorto collateral.
In a young person who has high blood pressure it is very important to measure blood pressure in all 4 limbs for diagnosing coarctation of aorta which will produce a difference of 20 mmHg systolic blood pressure in the upper and lower limb.
This simple bedside clinical examination was missed in a 24 yr symptomatic hypertensive patient who was treated at various centres.The patient had exertional angina patient for which he underwent a coronary angiogram which showed large collateral arising from the right coronary artery to the descending aorta. CT aortogram confirmed the diagnosis of coarctation.
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Lessons. In a young hypertensive always suspect co arctation of aorta and check blood pressure in all four limbs.
A detailed pre procedure planning by a skilled heart team at a specialized tertiary cardiac care centre is the key to success in complex procedures.
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