Manifestation of juxtaductal coarctation after surgical ligation of persistent ductus arteriosus in infancy.

Abstract

Coarctation of the aorta was observed in 2 infants after surgical interruption of the ductus arteriosus. In a further 3 patients transient, but severe, upper limb hypertension in the postoperative period required antihypertensive therapy. The relevance of these findings to the pathogenesis ofjuxtaductal coarctation is discussed and their surgical importance is stressed, as the situation can be easily corrected if recognized on the operating table. Rudolph (I970) and Rudolph, Heymann, and Spitznas (I972) recently reported aortic obstruction becoming evident in neonates who at, or soon after, birth had no clinical evidence of coarctation. They suggested that while the ductus remained open it acted as a conduit bypassing the site of potential obstruction in the aortic lumen. With postnatal constriction, a pressure gradient developed at the junction of the aortic isthmus with the descending aorta, producing juxtaductal coarctation. They were able to simulate this experimentally in fetal lambs. The human counterpart of this experimental work, namely production of a pressure difference between ascending and descending aorta, after surgical interruption of the ductus, has not been adequately documented. The object of this paper is to describe the development of such a pressure difference in 2 infants who subsequently required resection of a localized juxtaductal coarctation. Transient upper limb hypertension developed in a further 3 infants after operation. The findings in the 5 patients are then considered in relation to the pathogenesis of coarctation (Shinebourne and Elseed, I974) and surgical management of persistent ductus arteriosus in infancy. Case histories Case i A baby girl, born on 4 August I97I, birthweight 2-3 kg, was kept in a premature unit for 2 weeks. At 6 weeks there was onset of difficulty with feeding, associated with failure to gain weight. She was admitted to Brompton Hospital aged Iii weeks with heart failure and a cardiac murmur.

Coarctation, tubular hypoplasia, and the ductus arteriosus. Histological study of 35 specimens.

“…The lesion could be proximal to, opposite to, or distal to the ductus arteriosus. Rudolph et al (1972) introduced the term 'juxtaductal' coarctation and this term has since been used by other workers Elseed et al, 1974).…”

Echocardiographic Evidence for a Ductal Tissue Sling Causing Discrete Coarctation of the Aorta in the Neonate: Case Report

“…Abnormal fetal hemodynamics has been proposed to explain arch obstruction in patients with interrupted aortic arch with ventricular septal defect or in patients with simple isthmic hypoplasia [2,9,11]. Additionally, a normal posterior infolding of the aorta across from the ductal insertion has been described.…”