A 19-year-old man with a history of successful end-to-end anastomosis surgical repair of coarctation of the aorta was admitted to our institution for a murmur evaluation before applying for a sport licence. He was asymptomatic and was not taking any medication. A systolic murmur was heard in the aortic area and in the back. The patient was normotensive, with 120/60 mmHg on each arm. Echocardiography did not show valvular disease or intraventricular obstruction. The ascending aorta was normal and there was an acute angulation between the ascending and the descending aorta, without the horizontal part. This is characteristic of a ‘Gothic’ arch ( Fig. 1 ). There was neither two-dimensional nor Doppler evidence of recoarctation. Cine cardiac magnetic resonance showed a hypointense jet in the angulation of the aorta ( Fig. 2 ). Such an image is associated with acceleration of blood velocity in the angulation, which is responsible for the murmur. Unfortunately, no flow sensitive sequence was performed. Exercise testing identified an induced hypertension, reaching 250/90 mmHg, without any difference between arms.
