THE CARDIAC OUTPUT AND OTHER MEASUREMENTS OF THE CIRCULATION IN COARCTATION OF THE AORTA

Coarctation of the aorta; surgical treatment of 100 cases

Coarctation of the aorta can be recognized in most instances by simple findings of physical examination. The anomaly is one which carries a variable prognosis. The condition may be tolerated through a long life with little incapacitation or may be accompanied by early and serious complications in the form of cardiac failure, aortic rupture, or intracranial hemorrhage. In a high percentage of patients it is possible to remove the aortic block and establish a pathway of satisfactory size. A series of cases shows that there is an excellent chance of relieving hypertension by such surgery. Mortality rates for these operations have not been unduly high. Certain complicated types of cases carry too high a risk and should not be accepted for surgery.

Paradoxical hypertension after repair of coarctation of the aorta: a review of its causes

Correction of a coarctation of the aorta, an apparent simple cause of hypertension, paradoxically can provoke two hypertensive responses, one of which is potentially fatal. The first, limited to the first 24 hours, occurs in nearly one half of the patients. This is likely due to the high set of the carotid baroreceptors. The second, which may be associated with abdominal pain and, in some, with necrosis of the small bowel as a result of severe arteritis confined to arteries arising from the aorta below the coarctation, develops in about one half of the first responders. Norepinephrine excretion greatly increases for several days, whereas angiotensin levels are elevated for 3 to 4 days. The hypertension responds to beta-blockers, to arterial smooth muscle relaxants, and to angiotensin converting enzymes. A theory is advanced to explain the second response. It is the adaptation gone awry that ensures adequate flow to exercising muscles below the coarctation, above and beyond that delivered by increasing the systolic pressure. It could be a regionally controlled mechanism similar to the rationing of blood flow in diving mammals.

Coarctation of the abdominal aorta: pathophysiologic and therapeutic considerations

Coarctation of the aorta is the most frequent cause of hypertension in infants and children. Ninety-eight per cent of coarctations occur in the descending aorta near the ligamentum arteriosus. Five patients are presented with the relatively rare problem of coarctation of the abdominal aorta. The anatomic,pathophysiologic and clinical aspects in these patients cover a range of variants. Clinical and laboratory studies of the genesis of hypertension in coarctation are reviewed in chronologic outline. An experimental model of abdominal coarctation with hypertensive and renin-angiotensin II correlations suggests but does not prove a renal mechanism for the hypertension. The same conclusion must be drawn from study of the clinical cases.

General hemodynamics and splanchnic circulation in patients with coarctation of the aorta

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The Surgical Treatment and the Physiopathology of Coarctation of the Aorta

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