Coarctation of the Aorta

Abstract

The surgical therapy of coarctation of the aorta consists of resection of the narrowed segment and reestablishment of continuity of the vessel by end-to-end anastomosis or the insertion of a graft. Certain complications may be expected because of the nature of the surgery : hemorrhage, aneurysm formation, rupture of the anastomosis, infection. Another, which is due primarily to the success of the operation, is a peculiar obstruction in the network of small vessels supplying the lower body organs. The peripheral manifestations relate chiefly to involvement of the intestine, and it is with these that this communication is concerned. Report of CasesCase 1.\p=m-\A boy, aged 5, was admitted to Hahnemann Hospital on June 5, 1950. Two months earlier a diagnosis of coarctation of the aorta had been made. There had been no symptoms.On physical examination the carotid arteries pulsated prominently. There was slight enlargement of the heart to the left. No thrill was palpable. The second sound at the base to the right and left of the sternum was normal. In the third and fourth left interspaces near the sternal border was a loud harsh systolic murmur which was transmitted over the left chest. In the right second interspace was a systolic murmur which was of liigher pitch. Radial artery pulsations were normal ; no pulsations could be felt in the lower extremities. Blood pressure in the arms was 156/110; it could not be measured in the legs.Laboratory Data.-The electrocardiogram showed left axis deviation and no evidence of left ventricular hypertrophy. On films and fluoroscopy the significant abnormalities were widening of the ascending aorta and erosion of the inferior border of the right 10th rib. Thoracic aortography demonstrated dilatation of the ascending and trans¬ verse portions of the aorta and of the left subclavian artery. Just distal to the origin of the latter vessel was a short area of marked coarcta¬ tion. There was no postcoarctation dilatation. Collateral vessels were of moderate prominence.Hospital Course.-Diagnoses of coarctation of the aorta and associated stenosis of the aortic valve or subvalvular obstruction to aortic flow were made. On June 11 the child was operated upon by Dr. C. P. Bailey. The area of coarctation was excised, and an end-to-end anastomosis was accom¬ plished without difficulty. The diameter of the lumen of the excised segment in its narrowest portion was 1 mm. The duration of the procedure was approximately 3J4 hours, and the aorta was clamped for 45 minutes. Four hundred cubic centimeters of blood was given. The blood pressure in the arms after skin closure was 120/90. It was 132/112 in the legs. Fluid by mouth was allowed as soon as re¬ quested, and intake of solid food was started on the first postoperative day. During the next day there were no unusual developments. The blood pressure in the arms rose to 140/98 and remained at this level. On the third day the boy began to complain of abdominal discomfort and his abdomen became markedly distended. Peristaltic sounds were normal at s...