Surgical treatment of coarctation of the aorta; report of a case: Shick, R. M.: Proc. Staff Meet., Mayo Clin. 22:127 (April 2), 1947

Abstract

This condition is found two to three times more frequently in females than in males. It is usually a congenital anomaly, though the adult type has been reported as a result of Streptococcus viridans infection. The lesion itself is a narrowing or constriction of the aorta in the region of the insertion of the ductus arteriosus or its vestige. In 25 per cent of these cases, the aortic valve is bicuspid. This gives rise to a narrowing of the lumen and thinning of the walls of a part or all of the aorta with a consequent reduction of the volume of blood flowing through it. This same thinning of the walls is evident in the cerebral vessels. Survival and capacity for work in such patients depend upon the establishment of collateral circulation through the anastomoses between aorta and subclavian, intercostal, and epigastric arteries. Its diagnosis rests upon symptoms and signs developing along this collateral circulation. These are in the order of their frequency and importance: 1.1. Hypertension and high pulse pressure in the upper extremities both as compared to normal and to that of the lower extremities.2.2. Notching and erosion of the lower rib margins as seen in the x-ray3.3. Pulsations, thrills, bruits, and other sounds along the course of the collateral circulation.4.4. Gradually diminishing pulse volume as the terminal arteries of the lower extremities are approached.The greatest danger of pregnancy, and particularly labor, in these patients is sudden rupture of the thinned-out aorta or cerebral vessels. It is therefore usually advised that pregnancy be avoided by contraceptive devices, or if pregnancy has occurred despite these, interruption be done early. If the patient has been carried to near term, she should be delivered by cesarean section with tubal sterilization.