Application of duplex ultrasonography in the midaortic syndrome

Objective.- Midaortic syndrome is a rare condition found primarily in children that causes stenosis of the abdominal aorta and its proximal branches. Duplex interpretation criteria derived from adults do not necessarily apply to the pediatric population but are sometimes used empirically in specific cases. We report the case of a 5-year-old girl whose aorta and renal arteries were studied by duplex ultrasound, with anatomic and radiologic correlation. Case Report.- The patient was a 5-year-old girl with refractory hypertension on multiple anti-hypertensive medications. Her initial diagnosis of midaortic syndrome was made via duplex ultrasound. The findings were confirmed by angiography and showed smooth narrowing of the mid- to distal abdominal aorta with concomitant bilateral renal artery origin stenosis. Surgical repair of the aorta was performed with the use of a patch angioplasty technique with pulmonary artery homograft. The left renal artery was re-implanted onto the infrarenal aorta and an aorta to right renal artery bypass graft was placed using autogenous left internal iliac artery. Duplex ultrasound was then used to evaluate the success of the surgical repair. Conclusion.- Duplex ultrasound proved effective in the preoperative and postoperative care of this small child with midaortic syndrome and renal artery stenosis. The standard adult criteria for renal artery stenosis can be used selectively in children to assist in the diagnosis of unusual vascular conditions.