A transthoracic echocardiogram was done which showed biatrial dilatation, right ventricular dilatation, slightly decreased left ventricular systolic function, severe aortic regurgitation, a possible bicuspid aortic valve with vegetation, an enlarged aortic root, severe tricuspid regurgitation with moderate to severe pulmonary hypertension, tricuspid valve vegetation, a possible non coronary sinus of Valsalva aneurysm with perforation to the right atrium and severe coarctation at the aortic isthmus
with a maximum peak gradient of 77 mmHg (Figure 1).
According to these criteria, AAH is present if the AA diameter between the innominate artery and the left common carotid artery is <60% of the ascending aorta diameter, if the AA diameter between the left common carotid artery and the left subclavian artery is <50% of the ascending aorta diameter, or if the diameter of the aortic isthmus
is <40% of the ascending aorta diameter.
On CT scan of chest and abdomen, with contrast, he was found to have a right pulmonary contusion, a low-grade splenic laceration, a mesenteric hematoma, and a descending aortic isthmus