Coarctation of the Aorta and a Parachute Mitral Valve in an Adult With Differential Cyanosis

Differential cyanosis may occur in Eisenmenger physiology in the presence of a patent ductus arteriosus (PDA). We present a unique case of a 22-year-old male manifesting as cyanosis of the left upper extremity and both lower extremities, but with preservation of the right upper extremity. Work-up revealed multiple congenital defects, reminiscent of the Shone's complex. Survival into adulthood is presumed to be due to a PDA, at the expense of a right-to-left shunt. This report highlights the interplay of multiple anomalies documented on echocardiography and MRI, wherein diagnosis was made non-invasively.