Postnatal development of obstruction in coarctation of the aorta: role of the ductus arteriosus.
Postnatal development of obstruction in coarctation of the aorta: role of the ductus arteriosus.
复制标题
主动脉缩窄阻塞的产后发展：动脉导管的作用。
DOI：
10.1542/peds.56.4.562
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发表时间：
1975
期刊：
影响因子：
8
通讯作者：
M. A. Berman
中科院分区：
文献类型：
--
作者：
N. Talner;M. A. Berman
通过临床、血流动力学和血管造影研究，明确了两名患有主动脉缩窄的婴儿发生急性梗阻的一系列事件。一名婴儿的大动脉关系正常，仅有孤立的主动脉缩窄；另一名婴儿为大动脉转位，伴有右心室发育不良、室间隔缺损、主动脉峡部狭窄以及局限性主动脉缩窄部位。在每例中，通过血管造影都能观察到主动脉后壁嵴——主动脉缩窄的基本病理病变。然而，只要动脉导管广泛开放，就没有主动脉梗阻的迹象。在动脉导管闭合后，股动脉搏动减弱，升主动脉和降主动脉之间记录到收缩压峰值差，并且看到动脉导管旁缩窄的离散区域。基本的畸形（主动脉后壁帘）似乎在子宫内就存在，可能是一个主动脉分支点。只要血液能够通过动脉导管的主动脉端穿过主动脉峡部进入降主动脉，这种病变就不会造成梗阻。出生后，随着动脉导管在其主动脉插入处发生收缩，急性主动脉梗阻的迹象可能会变得明显。新生儿检查时股动脉搏动正常并不能明确排除主动脉缩窄。如果婴儿无症状，儿科医生应在2周龄时再次检查；如果有心力衰竭的迹象，则应更早检查以确定是否存在这种缺陷。
The sequence of events leading to the development of acute obstruction in two infants with coarctation has been defined by clinical, hemodynamic, and angiographic studies. One infant had normally related great arteries and an isolated coarctation, while the other infant had transposition with a hypoplastic right ventricle, a ventricular septal deffect, narrowing of the aortic isthmus, and a localized site of coarctation. In each instance, a posterior aortic shelf--the basic pathologic lesion in coarctation--could be observed angiographically. Signs of aortic obstruction were absent, however, as long as the ductus arteriosus was widely patent. Following ductal obliteration, femoral pulsations diminished, a peak systolic pressure difference was recorded between the ascending and descending aorta, and a discrete area of juxtaductal coarctation was seen. The basic malformation (posterior aortic curtain) would appear to exist in utero, possibly as an aortic branch point. This lesion is nonobstructive as long as blood can traverse the aortic isthmus through the aortic end of the ductus into the descending aorta. Postnatally, as the ductus arteriosus undergoes constriction at its aortic insertion, signs of acute aortic obstruction may b =ecome apparent. Normal femoral arterial pulsations during the newborn examination do not definitively exclude coarctation. Pediatricians should recheck at 2 weeks of age if the infant is asymptomatic or sooner if there are signs of cardiac failure to establish the presence or absence of this defect.