Related Experiment Videos
Angiocardiographic study of coarctation of the aorta--morphology and morphogenesis
Insights
Coarctation of the aorta (COA) is often linked to other heart defects that can impede fetal blood flow. Angiocardiography reveals that isthmus narrowing and distal stenosis are common in COA, suggesting prenatal blood flow issues.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Coarctation of the aorta (COA) is a congenital heart defect.
- Understanding its morphogenesis is crucial for effective treatment.
- Associated cardiac anomalies can significantly impact COA presentation.
Purpose of the Study:
- To analyze the angiocardiographic morphology of COA.
- To investigate associated cardiac anomalies and their impact on morphogenesis.
- To evaluate the relationship between fetal blood flow and COA development.
Main Methods:
- Analysis of 154 clinical cases of COA.
- Detailed review of aortograms from 41 COA patients (ages 1 month to 20 years).
- Comparison with 37 age-matched control cases.
Main Results:
- 88% of COA cases showed isthmus narrowing; 89% had distal isthmus stenosis.
- Associated anomalies like VSD narrowed the left ventricular outflow tract.
- Hypoplastic isthmus in infants could normalize by age 5.
- In some infants, ductus arteriosus constriction and pulmonary hypertension obstructed aortic flow.
Conclusions:
- Prenatal decrease in ascending aorta blood flow likely causes ischemic hypoplasia in COA.
- Localized stenosis may relate to abnormal ductal tissue distribution and postnatal ductal constriction.
- COA morphology is influenced by both congenital anomalies and postnatal hemodynamic changes.
Abstract:
Angiocardiographic morphology and associated cardiac anomalies of the coarctation of the aorta (COA) were analysed in the light of recently advanced theory of its morphogenesis. Analysis of 154 clinical cases of COA revealed the presence of associated cardiac anomalies which could obstruct fetal blood flow to the ascending aorta in many cases. Systolic left ventricular outflow tract was significantly narrow in cases of ventricular septal defect (VSD) associated with COA in comparison with the isolated VSD (p less than 0.01). Good quality aortograms obtained from 41 cases of COA were analysed. Ages ranged from one month to 20 years and major cardiac anomalies were associated in 25 cases. Age-matched 37 cases were studied as the controls. In COA, the isthmus was narrower than the controls in 88% of the cases, and in the remaining it was low in the normal range. Severely hypoplastic isthmus in early infancy became the adult type after 5 years in one of the 4 cases which had repeated aortography. Localized stenosis at the distal end of isthmus was present in 89%, and absent in 11% (4 cases). In these 4, isthmal narrowing was associated with major intracardiac anomalies, large patent ductus arteriosus (PDA) and pulmonary hypertension (PH). The anterior ostium to the descending aorta was obstructed by constricted ductus arteriosus (PDA) and pulmonary hypertension (PH). The anterior ostium to the descending aorta was obstructed by constricted ductus arteriosus in some infants with COA. These angiographic findings are compatible with the following working hypothesis: ischemic hypoplasia results from prenatal decrease of blood flow to the ascending aorta, and localized stenosis is related to abnormal distribution of the ductal tissue to the descending aorta and post-natal constriction of the ductus arteriosus. In 3 infants COA was associated with persistent fifth aortic arch.