Hypertension from coarctation of the aorta

Abstract

In the management of patients who are known to have hypertension, it is important to identify those who have an aortic obstruction, since surgical removal of an aortic block is a very effective method of therapy. Coarctation can be detected quickly and by very simple means with the use of a few observations with methods which are easily available to any practitioner in his office. It is rare that more complicated forms of study, such as catheterization or angiography, are required to establish the diagnosis. While aortic blocks are generally tolerated very well through childhood years, they take an increasing toll in adults and bring about complications or fatality largely from the effects of the hypertensive state which is secondarily produced. It is believed that in any large series of untreated patients with coarctation, the average length of life is about half that of the normal life expectancy which currently exists for the population at large. Surgery for treatment of a coarctation, by removal of the obstruction and reconstruction of the aortic pathway, has been put on a sound surgical basis and has a mortality of only a few per cent. Following surgical removal of coarctations, observations on patients show that a very high proportion of subjects can attain a marked reduction in hypertension. Likewise, in most instances a striking improvement in electrocardiographic abnormalities and in reduction of heart size has been rated when these were abnormal before operation. The optimal ages for surgical resection of aortic coarctation lie between eight and twenty years, although many excellent results can be attained below and well above this range.