Aortic coarctation pathophysiology: Difference between revisions
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{{ | {{Aortic coarctation}} | ||
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==Pathophysiology== | ==Pathophysiology== | ||
Coarctation of the aorta can be | Coarctation of the aorta can be: | ||
*'''Congenital coarctation''' resulting from an infolding of the aortic media that incorportaes ductal tissue, forming a ridge that eccentrically narrows the lumen of the vessel. Subsequent intimal proliferation on the ridge leads to progressive narrowing of the vessel lumen. There is a dilatation before and after the narrowing, giving the aorta an hourglass appearance. The exact etiology of the aortic abnormality remains unclear but likely involves a defect in the vascular wall of the aorta due to reduced antegrade intrauterine blood flow or to constriction of ductal tissue extending into the thoracic aorta. | |||
*'''Acquired coarctation''' occurring in systemic arteritides such as [[Takayasu arteritis]]. Additionally it may occur in rare cases of severe [[atherosclerosis]]. | |||
===Defect location=== | |||
#95% of the lesions are located distal to the left [[subclavian artery]] and proximal to the [[ductus arteriosus]] (preductal coarctation) or just at or distal to the ductus (postductal coarctation). | |||
#5% of coarctations are located proximal to the left [[subclavian artery]], or rarely in the abdominal [[aorta]]. | |||
#In some cases, coarctation presents as a long segment or a tubular hypoplasia. | |||
The stenosis is caused by an infolding of the left posterolateral aspect of the aortic wall resulting in an eccentric narrowing. | |||
===Sites of secondary dilation=== | |||
#Aorta proximal to the coarct | |||
#Aorta distal to the coarctation | |||
#Left subclavian artery | |||
The narrowing progresses throughout life, and extensive collaterals develop from the subclavian (predominantly) and [[axillary arteries]] through: | |||
#[[Internal mammary artery]] | |||
#[[Scapular artery]] | |||
#[[Intercostal arteries]] | |||
#Epigastric arteries | |||
#[[Anterior spinal arteries]] | |||
==References== | ==References== | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Disease state]] | ||
[[Category:Congenital heart disease]] | |||
[[Category:Overview complete]] | |||
[[Category:Mature chapter]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 17:35, 16 August 2011
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Aortic coarctation pathophysiology On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Pathophysiology
Coarctation of the aorta can be:
- Congenital coarctation resulting from an infolding of the aortic media that incorportaes ductal tissue, forming a ridge that eccentrically narrows the lumen of the vessel. Subsequent intimal proliferation on the ridge leads to progressive narrowing of the vessel lumen. There is a dilatation before and after the narrowing, giving the aorta an hourglass appearance. The exact etiology of the aortic abnormality remains unclear but likely involves a defect in the vascular wall of the aorta due to reduced antegrade intrauterine blood flow or to constriction of ductal tissue extending into the thoracic aorta.
- Acquired coarctation occurring in systemic arteritides such as Takayasu arteritis. Additionally it may occur in rare cases of severe atherosclerosis.
Defect location
- 95% of the lesions are located distal to the left subclavian artery and proximal to the ductus arteriosus (preductal coarctation) or just at or distal to the ductus (postductal coarctation).
- 5% of coarctations are located proximal to the left subclavian artery, or rarely in the abdominal aorta.
- In some cases, coarctation presents as a long segment or a tubular hypoplasia.
The stenosis is caused by an infolding of the left posterolateral aspect of the aortic wall resulting in an eccentric narrowing.
Sites of secondary dilation
- Aorta proximal to the coarct
- Aorta distal to the coarctation
- Left subclavian artery
The narrowing progresses throughout life, and extensive collaterals develop from the subclavian (predominantly) and axillary arteries through:
- Internal mammary artery
- Scapular artery
- Intercostal arteries
- Epigastric arteries
- Anterior spinal arteries