PMC4728598_01
Chest X-ray showing an enlarged cardiac silhouette at the expense of the
right ventricular border, with increased pulmonary vasculature,
especially in the pulmonary hila. The aorta is not bulging despite the
coarctation, but there is hyperrefringency on the edge of the ribs. The
electrocardiogram highlights signs of first-degree atrioventricular
block and complete right bundle-branch block.
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QRS Duration: 0.14", PR 0.21 ms (Figure 1). There was no aortic dilatation, but hyperrefringency on the lower edges of the ribs was observed (Figure 1).
Transesophageal echocardiography shows two ASDs, measuring 8 and 26 mm,
in A. Magnetic resonance imaging clearly depicts, in B and C, the aortic
coarctation after the left subclavian artery with exuberant collateral
circulation into the descending aorta; at the angiography in D, extreme
aortic coarctation showing actual aortic disruption after the left
subclavian artery and the 15 x 40 mm stent placed at this site, in E;
and closure of the ASD using the CERA( ) device in F, together
with stent implant in the aorta (arrows).
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Marked right chambers and pulmonary trunk enlargement was also observed (Figure 2). There was immediate BP normalization and equalization in the ascending and descending aorta (128/88-101 mmHg) after adequate dilation of the region (Figure 2).