Coarctation of the Aorta

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Abstract
During Recent years several cases of atypical coarctation of the aorta have been reported, including what Steinberg (1956) calls pseudocoarctation, an isthmic stenosis without abnormal hemodynamic consequences. It has been pointed out by Stevens (1958), however, that in such cases one can hardly speak of a true coarctation, but rather of a buckling of the aorta due to an unusually short ligamentum arteriosum. He did not find actual stenosis of the lumen, although radiologically this might be suggested by the kinking of the aorta. From Sweden, Karnell (1959) has published a large series of cases of coarctation of the aorta studied by preoperative as well as postoperative aortography. Especially has he examined the intraarterial pressure before and after operation and found that for all age groups the systolic tension proximal to the coarctation was raised, on an average, whereas the diastolic pressure was not significantly abnormal. Direct examination of the intra-arterial pressure revealed a pulse amplitude which proximal to the stenosis was three times that measured distally. The median pressure averaged 30 mm. Hg higher in the upper limbs than in the lower. Prompted by these American and Swedish investigations, we studied our series with a special view to the influence of the stenosis upon hemodynamic conditions. We were interested particularly in the relation between the width of the aorta proximal and distal to the stenosis, on the one hand, and in the intra-arterial pressure as well as the pressure gradient between the upper and lower limbs, on the other. Since the results of our studies are not entirely in keeping with previous findings, they will be reported here. The series includes 56 patients with coarctation. Sex ratio and age distribution were as follows: As is usual, males predominate, but the male preponderance is somewhat less marked (a ratio of 1.8:1) than in most other series, in which it has been found to be about 2.5:1 to 3.0:1 (Brodén and Kamell, 1958; Holzmann, 1952). Diagram 1 gives a survey of the frequency of rib notching in relation to age. In our series, notching did not occur with great frequency until the age of eleven to fourteen years. This is not quite in agreement with previous findings (Figley, 1954; Kjellberge et al., 1955). Measurement of the intra-arterial pressure in the upper and lower limbs was done in 35 cases. These cases were studied in particular detail with respect to hemodynamic function and aortic dimensions. Measurements were made, in the lateral and anteroposterior projection, of the diameter of the ascending aorta at the site of its greatest width and of the descending aorta at the level of the diaphragm. From these figures the corresponding area of the cross section was calculated. The relation between these cross-section areas has been shown in aortograms and angiocardiograms of persons in whom no disease could be found to be normally about 4.00.

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