Asymptomatic severe aortic coarctation in an 80-year-old man.

Survival to advanced age is exceptional in patients with unrepaired aortic coarctation. We report the case of a hypertensive 80-year-old man with coarctation of the aorta who was otherwise asymptomatic. Coarctation was suspected when a femoral-radial pulse delay was noted during his routine physical examination. A 25-mmHg systolic blood pressure gradient between the upper and lower extremities was detected. Subsequent magnetic resonance angiography, aortography, and coronary angiography revealed severe coarctation of the aorta, well-developed collateral vessels, and severe coronary artery disease that included the left main artery. Coronary artery bypass grafting was performed, and the coarctation was managed conservatively with antihypertensive medication. At the 1-year follow-up visit, the patient was still asymptomatic and maintained a normal blood pressure with medication.