TITLE:
Middle Aortic Syndrome Revealed by Resistant Hypertension in Young Women from Sub-Saharan Africa: A Case Series of Three Patients
AUTHORS:
Ndobo Valérie, Maimouna Mahamat, Abo’o Tatiana, Mve Mvondo Charles, Siddikatou Djibrilla, Arroye Fabrice, Mbede Maggy, Jerome Boombhi, Kuate Mfeukeu Liliane, Maodo Diop, Aliou Ngaide, Nganou Gnindjio Chris Nadège, Ba Hamadou
KEYWORDS:
Middle Aortic Syndrome, Resistant Hypertension, Takayasu Arteritis, Renal Artery Stenosis, Postpartum
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.16 No.4,
April
29,
2026
ABSTRACT: Background: Middle aortic syndrome and renovascular disorders are rare but serious causes of secondary hypertension in young adults. Their diagnosis may be delayed, particularly in young women, when hypertension is initially attributed to pregnancy, the postpartum period, or essential hypertension. This three-case series reports three distinct patterns of severe arterial disease in young women from sub-Saharan Africa presenting with resistant hypertension: a probable inflammatory form consistent with Takayasu arteritis, a form compatible with middle aortic syndrome revealed in the postpartum period, and significant left renal artery stenosis complicated by major renal functional impairment. The main interest of this case series was to show that focused clinical examination and vascular imaging can reveal rare anatomical lesions responsible for severe hypertension and high cardiorenal risk in a resource-limited setting. Case 1: involved a 38-year-old woman with long-standing severe hypertension complicated by a pregnancy-related stroke with fetal loss in the second trimester, associated with an inflammatory syndrome, fever, a systolic murmur, and diminished femoral pulses. Computed tomography angiography concluded to middle aortic syndrome of probable inflammatory origin, consistent with Takayasu arteritis, with diffuse aortic involvement and severe bilateral renal artery disease. Case 2: involved a 27-year-old primigravida who had previously been normotensive and developed hypertension at 32 weeks of gestation, which persisted postpartum despite quadruple antihypertensive therapy. Examination revealed a blood pressure difference between the upper and lower limbs, a dorsal systolic murmur, and diminished femoral pulses. Imaging investigations supported the diagnosis of middle aortic syndrome with severe stenosis of the aortic isthmus associated with tight ostial stenosis of the left renal artery. Case 3: involved a 27-year-old woman with resistant hypertension evolving over one year, associated with an abdominal bruit suggestive of renovascular disease. Dynamic renal scintigraphy showed marked functional asymmetry, with left kidney function limited to 15%, consistent with renovascular hypertension secondary to significant stenosis of the left renal artery. Conclusion: This case series shows that any resistant hypertension in a young woman, particularly in the setting of pregnancy or the postpartum period, should prompt investigation for a secondary vascular cause, especially middle aortic syndrome or renovascular disease. The key message is that the combination of simple clinical clues (blood pressure difference between limbs, absent or diminished femoral pulses, vascular bruit) and targeted imaging examinations, particularly Doppler ultrasound, computed tomography angiography, and renal scintigraphy when indicated, can establish the diagnosis, assess functional impact, and guide therapeutic strategy. In our setting, however, limited access to revascularization remains a major obstacle to optimal management of these patients.