主动脉缩窄疾病课件.ppt

Coarctation of Aorta Seoul National University Hospital Department of Thoracic Cardiovascular Surgery Coarctation of Aorta 1. Definition A congenital narrowing of upper descending thoracic aorta adjacent to the site of attachment of ductus arteriosus 2. History Morgagni : 1st description in 1760 Bonnett : postductal preductal type in 1903 Crafoord : 1st coarctation repair in 1944 Vorsschulte : prosthetic onlay graft or vertical incision and transverse closure in 1957 Waldhausen : subclavian patch aortoplasty in 1966 Coarctation of Aorta Developmental factor 1. Underdevelopment or hypoplasia of aortic arch or isthmus Definition of hypoplasia * Proximal arch : 60% of ascending aorta * Distal arch : 50% of ascending aorta * Isthmus : 40% of ascending aorta 2. Presence of ectopic ductal tissue in the aorta Aortic Arch Hypoplasia Definition Hypoplastic arch has higher ratio of elastin lamellae to vessel diameter increase in collagen and decrease in alpha-actin-positive cell that may hinder the ability of arch to distend. 1. 50% reduction of terminal end of ascending aorta, sometimes, because of small ascending aorta in coarctation, descending thoracic aorta is compared. 2. Transverse arch diameter less than body weight in Kg plus 1 3. Z-value less than –2 or more Coarctation of Aorta Morphology 1. Localized stenosis * More than 50% reduction in cross sectional area * Shelf, projection, infolding of aortic media into the lumen opposite the ductus arteriosus * Usually intimal hypertrophy ( intimal veil ) extends the shelf circumferentially and further narrows the lumen (Rodbard) 2. Tubular hypoplasia * Severe with lesser narrowing * Proximal aortic arterial wall * Distal aortic arch narrowing