Why the study?
Survival into adulthood without repair of coarctation of the aorta is uncommon, and aortic dissection, particularly involving the descending aorta, is an exceedingly rare complication in this context.
This case underscores the importance of recognizing congenital aortic disease as a cause of refractory hypertension in adults and highlights that acute type B aortic dissection can rarely complicate unrepaired coarctation of the aorta.
Supports screening for congenital aortic disease in refractory hypertension; hypothesis-generating for type B dissection in unrepaired coarctation.
Coarctation of the aorta (CoA) is a congenital narrowing typically detected in childhood; survival into adulthood without repair is uncommon. Aortic dissection (AD) is an exceedingly rare complication in this specific context, particularly involving the descending aorta. We describe a case of a 46-year-old Caribbean-Black male with a medical history of chronic hypertension (HTN) who presented with unstable angina and hypertensive crisis. Emergent computed tomography angiography revealed critical proximal descending CoA with poststenotic dilatation and an acute Stanford type B AD. He was initially stabilized on guideline-directed medical therapy, and while definitive surgical repair was recommended, the patient declined. This exceedingly rare case of type B AD complicating unrepaired CoA underscores the importance of recognizing congenital aortic disease as a cause of refractory HTN in adults. Additionally, it highlights the need for continued vigilance for long-term complications in adults with congenital heart disease.
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Ramcharan et al. (2026) studied this question.
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