Coarctation of the aorta is a common congenital anomaly. it is the third most common lesion in Abbott´s report, sixth most common in wood´s series. Coarctation of the aorta was first successfully resected with end-to-end anastomosis by Crafoord of Stockholm followed a very short time later by a similar operation by Gross. many prefer to classify the cases of coarctation of the aorta into the so called "infantile" and "adult" types, but it has been of little practical aid in the understanding of the pathophysiology of the desease. It has been rather popular to utilize the more precise descritive classification of Edwards.
A. Coarctation of the aorta with closed ductus arteriosus
1) Coarctation in the vicinity of the ligamentum arteriosum
2) Coarctation in unusual locations
3) Coarctation with stenosis of the right or left subclavian artery B. Coarctation of the aorta with patent ductus arteriosus
1) Coarctation of the aorta distal to the aortic mouth of he ductus
2) Coarctation proxismal to the aortic mouth of the ductus
Clinincal signs of coarctation of the aorta are few, though the diagnosis may be made in most cases by reoutinely palpating the femoral arteries. No pulse or diminished pulsation will be felt in the lower extremeties. However in the cases of Preductal Coarctation there may be lower limb cyanosis with clubbing the toes.
Additional diagnostic aids consist of the plain Roentgenogram and Barium swallow of the esophagus which may show hypertiophy of the left ventricle, notching of the ribs, and indentation of the esophagus. Every effort should be made to avoid damaging the collateral circulation or occluding the left subclavian artery during the operation. It has been suggested to use interrupted suture in children on at least a portion of the circumference of the aorta.
Following resection, of a coarctation, many surgeons have observed patients who exhibited continued hypertension. Pallor abdominal pain, sweating, and palpitation, which response is apparently due to an increased secretion of Norepinephrine. This is known as "Paradoxical Hypertension".
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