Introduction: Development of the aorta is a complex process that takes place during the third week of ges-tation. Congenital variants and anomalies of the aortic arch are important to recognize as they may be associated with congenital heart diseases and can have impor-tant implications for prognosis and management. Methods: We report a case of a 22-year-old woman who came to the hospital for intermitent palpitations, atypical chest pain and headaches. Her medical history included a systolic heart murmur and a low heart rate. On pshysical examination she was identified a grade 3/6 systolic murmur in the left infraclavicular region, pulsations in the intercostal spaces, weack pulses in the femoral arteries. The blood pressure was 170/80 mmHg in the left arm and 165/85 in the right arm, with a systolic pressure gradient of 35 between upper and lower extremities. The electrocardiogram showed sinus bradycardia 50bpm. The Holter monitor revealed sinus tachycardia 140bpm alternating with a normal heart rythm. The chest X-ray showed rib notching and figure of 3 sign.

Results: T he echocardiography showed a hypertro-phied left ventricle with hypertrabeculation of the in-fero-lateral wall; from the suprasternal view we found the signs of an aortic coarctation just beyond the left subclavian artery, with a peak systolic gradient of 96 mmHg and a peak flow velocity of 4.8m/sec. For clearly defining the location and anatomy of the coarctation, the patient underwent CT angiography examination that confirmed the diagnosis, and described collateral vessels and a common origin for right carotid artery, right subclavian artery and left carotid artery (bovine-type arch). The patient received antihypertensive treat-ment and was directed to an interventional cardiologist to evaluate her candidacy for surgical or percutaneous therapy. A cardiac MRI was recommended for left ven-tricular non-compaction suspicion.

Conclusions: Coarctation of the aorta is a relatively common defect with an excellent prognosis if surgery is performed in time, especially in severe simple coarc-tation. Unfortunately is frequently acompanied by other congenital heart diseases that have implications in prognosis and case management. The association with bovine-type arch is rare and has been shown to influence reacoarctation after end-to-end anastomosis.