Fernex et al. Journal of Medical Case Reports 2012, 6:241 http://www.jmedicalcasereports.com/content/6/1/241 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Postural orthostatic tachycardia syndrome after surgical correction of an aortic coarctation: a case report Lucie Fernex1*, Alessandra Coeytaux2, Thierry Rochat3, Saziye Karaca4, Stephen Perrig5, Haran Burri6 and Mathieu R Nendaz1 Abstract Introduction: We report a case of postural tachycardia syndrome occurring after the surgical correction of an aortic coarctation, and coexisting with upper airway resistance syndrome. Case presentation: A 29-year-old Caucasian man complained of extreme fatigue, daytime sleepiness, shortness of breath on exertion, light-headedness and general weakness on standing. These symptoms began shortly after the surgical correction of an aortic coarctation and became progressively more debilitating, impairing any daily activity. An extensive work-up revealed postural tachycardia syndrome and a coexisting sleep-related breathing disorder, characterized as upper airway resistance syndrome. Conclusion: This is the first reported case describing the occurrence of postural tachycardia syndrome after the surgical correction of an aortic coarctation. This case also provides evidence for the suggestion that this syndrome may coexist with upper airway resistance syndrome, although the exact nature of their relationship must still be better established. Introduction Postural tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance. It is characterized by an exag- gerated increase in heart rate on standing, without any substantial drop in blood pressure [1]. In this report, we describe a young male patient who was admitted for POTS shortly after the surgical correction of an aortic coarctation. To the best of our knowledge, this is the first reported case of POTS arising after this type of sur- gery. Additionally, a coexisting sleep-related breathing disorder characterized as upper airway resistance syn- drome (UARS) was diagnosed by an extensive sleep study. Diminished sleep quality in POTS has been reported in the literature [2] but has never been charac- terized by detailed polysomnography. * Correspondence: lucie.fernex@hcuge.ch 1Internal Medicine, Department of Internal Medicine, University Hospital of Geneva, Gabrielle-Perret-Gentil 4, Geneva 11 1211, Switzerland Full list of author information is available at the end of the article Case presentation Our patient is a previously asymptomatic 29-year-old Caucasian man who was diagnosed with isthmic aortic coarctation at the age of 28 years. At that time, he presented with progressive shortness of breath, signifi- cant chest pain and diminished exercise tolerance. His blood pressure was 150/90mmHg without treatment. Echocardiography showed dilatation of his ascending aorta (39×40mm) and a bicuspid aortic valve with mild insufficiency. Our patient underwent surgery three months after his symptoms began. The surgical technique was resec- tion of the long segment (4cm) of the coarcted aortic arch and a termino-terminal anastomosis of an inter- vascular number 16 polytetrafluoroethylene (PTFE) tube. Two thoracic collaterals were ligatured during the resection of the aortic segment. Surgery was performed without any immediate complication. The gradient of the coarctation was 60mmHg before surgery, and was normal after the procedure. After ten days of hospital stay, our patient was discharged. He was asymptomatic © 2012 Fernex et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.