Our Patient - Laboratory

Further laboratory tests are not indicated in an otherwise healthy young man with coarctation of the aorta. The presence of unusually severe hypertension in our patient, however, suggests the need for evaluation of renal function including urinalysis, blood urea nitrogen, serum creatinine and serum electrolytes including calcium and phosphorus. An elevated renin level need not be confirmed by testing, as the diagnosis of coarctation is not in doubt.

An echo-Doppler study is indicated in our patient to confirm the diagnoses, define anatomic details and evaluate certain physiologic measurements.

Evaluation of anatomy by echo-Doppler includes defining the structure and location of the coarctation, the transverse aortic arch and origin of the left subclavian artery. The study should measure the distance between the left subclavian artery orifice and the coarctation site. The study should define the structure and mobility of the aortic valve, size of the ascending aorta, as well as left ventricular mass, wall thickness, volume and function. The study must also identify additional, otherwise unsuspected, abnormalities.

Evaluation of physiology in our patient includes spectral wave Doppler quantification of obstruction at the coarctation as well as at the aortic valve. Aortic regurgitation also requires this assessment. Careful color Doppler exploration should be accomplished to further evaluate aortic regurgitation and to search for additional defects detected neither clinically nor by anatomic echo, such as a small ductus arteriosus that is occasionally present.