Annals of Pediatric Cardiology
About us | Current Issue | Archives | Ahead of Print | Instructions | Submission | Subscribe | Advertise | Contact | Login 
     
     
 


 

 
     
    Advanced search
 

 
 
     
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed2006    
    Printed36    
    Emailed0    
    PDF Downloaded77    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents   
IMAGES  
Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 310-311
Ductal aneurysm with postsubclavian coarctation of aorta in an adult


Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Click here for correspondence address and email

Date of Web Publication21-Aug-2017
 

   Abstract 


We describe a case of ductal aneurysm in an adult patient with post subclavian coarctation of aorta, which is a very rare association.

Keywords: Angiography, coarctation of aorta, ductal aneurysm, post subclavian

How to cite this article:
Behera DR, Nair KK, Sasidharan B. Ductal aneurysm with postsubclavian coarctation of aorta in an adult. Ann Pediatr Card 2017;10:310-1

How to cite this URL:
Behera DR, Nair KK, Sasidharan B. Ductal aneurysm with postsubclavian coarctation of aorta in an adult. Ann Pediatr Card [serial online] 2017 [cited 2021 May 8];10:310-1. Available from: https://www.annalspc.com/text.asp?2017/10/3/310/213357




A 41-year-old male with coarctation of aorta and systemic hypertension was evaluated with computed tomography (CT) angiography followed by cardiac catheterization and angiography, to assess the anatomy and pressure gradient. CT angiography demonstrated postsubclavian coarctation with minimum lumen diameter of 10.8 mm × 11.2 mm and focal anterior bulging of immediate coarctation segment and no collaterals [Figure 1]. Catheterization study showed pullback gradient of 24 mmHg across the coarctation segment. Aortic angiography confirmed postsubclavian coarctation with focal anterior bulging of immediate postcoarctation segment in the region of ductus arteriosus (DA) forming ductal aneurysm size of 23 mm × 20 mm [Figure 2].
Figure 1: (a and b) Computed tomography scan showing discrete postsubclavian coarctation of aorta with focal anterior pouching of ductus – ductal aneurysm

Click here to view
Figure 2: Aortic angiogram with marker pigtail in situ. (a) In lateral view, the discrete postsubclavian coarctation of aorta with focal anterior bulging of the ductus forming ductal aneurysm. (b) The dimensions. (c) posteroanterior view. Arrow marks showing ductal aneurysm

Click here to view


Ductal aneurysm is a focal outpouching at the arterial end of DA. It is a rare condition and usually presents in neonatal age group. In a series of 24 cases of neonatal ductal aneurysm, Dyamenahalli et al. found that most are isolated entities and only seven had associated syndromes such as Marfan syndrome, Smith–Lemli–Opitz syndrome, trisomies 21 and 13, and Ehlers–Danlos syndrome.[1] Hayashi et al. described a ductal aneurysm rapidly developing to a coarctation of aorta in a neonate.[2] It is rare in adulthood and its association with adult coarctation has never been reported. DA closes from its pulmonary end, and nonobliteration of aortic end of DA leads to the formation of ductal diverticulum. With subsequent transmission of high systemic pressures, it may enlarge to ductal aneurysm.[3] Usually, it possess an obtuse angle with aortic wall with smooth margin.[4],[5],[6] In the described patient as the coarctation is of moderate severity, the relatively high distal aortic pressure could have enlarged the ductal diverticulum to an aneurysm. On the contrary, if it was a tight coarctation, such large ductal aneurysm may not have been developed. This may be the reason for ductal diverticulum or aneurysms not being commonly reported with coarctation of aorta.

The most common differential diagnosis is aneurysmal dilation of the poststenotic segment of coarctation, which tends to be fusiform dilatation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Dyamenahalli U, Smallhorn JF, Geva T, Fouron JC, Cairns P, Jutras L, et al. Isolated ductus arteriosus aneurysm in the fetus and infant: A multi-institutional experience. J Am Coll Cardiol 2000;36:262-9.  Back to cited text no. 1
[PUBMED]    
2.
Hayashi T, Yoshizawa H, Yoshikawa Y. A ductal aneurysm rapidly developing into coarctation of the aorta. Eur J Cardiothorac Surg 2013;43:1264.  Back to cited text no. 2
[PUBMED]    
3.
Ohtsuka S, Kakihana M, Ishikawa T, Noguchi Y, Kuga K, Ishimitsu T, et al. Aneurysm of patent ductus arteriosus in an adult case: Findings of cardiac catheterization, angiography, and pathology. Clin Cardiol 1987;10:537-40.  Back to cited text no. 3
[PUBMED]    
4.
Kalisz K, Rajiah P. Radiological features of uncommon aneurysms of the cardiovascular system. World J Radiol 2016;8:434-48.  Back to cited text no. 4
[PUBMED]    
5.
Goodman PC, Jeffrey RB, Minagi H, Federle MP, Thomas AN. Angiographic evaluation of the ductus diverticulum. Cardiovasc Intervent Radiol 1982;5:1-4.  Back to cited text no. 5
[PUBMED]    
6.
Danza FM, Fusco A, Breda M, Bock E, Lemmo G, Colavita N. Ductus arteriosus aneurysm in an adult. AJR Am J Roentgenol 1984;143:131-3.  Back to cited text no. 6
[PUBMED]    

Top
Correspondence Address:
Bijulal Sasidharan
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram - 695 011, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_165_16

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top