Coarctation of the aorta presenting as systemic hypertension in a young adult

Background A 20-year-old male presented with a history of systemic hypertension. Examination revealed a systolic murmur with an early ejection click, and femoral pulses were markedly reduced. Investigations Physical examination, laboratory testing, electrocardiography, chest radiography, comprehensive echocardiography including pulsed- wave Doppler examination, and CT of the chest. Diagnosis Severe coarctation of the juxtaductal aorta accompanied by an ascending aortic aneurysm, a bicuspid aortic valve without evidence of hemodynamically significant stenosis or regurgitation, and an atrial septal defect. Management An ascending-descending intrapericardial aortic bypass graft, atrial septal defect closure, and ascending aorta replacement were all successfully performed. Lifelong follow-up will be required.