Case 1/2016 - Aortic Coarctation and Atrial Septal Defect submitted to Percutaneous Repair in Adult Patient

Clinical data: Heart murmur was identified at auscultation in childhood, but the diagnosis of aortic coarctation associated with atrial septal defect was attained when the patient was 15 years old. The patient practiced regular physical activity and did not report symptoms for up to 5 years, when he became sedentary. He received specific anti-hypertensive medication. Physical examination: patient was eupneic, acyanotic, obese, ample pulses in the upper limbs and decreased in the lower limbs. Weight: 113 kg; height: 177 cm; Body Mass Index (BMI): 36.1 kg/m2; RUL BP was the same in the LUL, 149/89 mmHg; right inferior limb BP = 113/77 mmHg; Heart rate (HR): 82 bpm; oxygen saturation of 95%. The aorta was clearly palpable at the suprasternal notch. The apex beat was not palpable in the precordium and there were no systolic impulses in the left sternal border (LSB). Normal heart sounds; constant split second sound and rough systolic murmur + / ++ / 4, was heard in the upper LSB. The liver was not palpable.