What is the pathologic anatomy of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

The classic coarctation of the aorta is located in the thoracic aorta distal to the origin of the left subclavian artery at about the level of the ductal structure. However, rarely, a coarcted segment is present in the lower thoracic or abdominal aorta. In such instances, the coarcted segment may be long and fusiform with irregular lumen; many consider these to be inflammatory or autoimmune in origin, and they may be variants of Takayasu arteritis.

Dilatation of the descending aorta immediately distal to the coarctation segment (poststenotic dilatation) is usually present. A jet lesion on the wall of the aorta distal to the coarctation site may also be present. Varying degrees of hypoplasia of the isthmus of the aorta (the portion of the aorta between the origin of the left subclavian artery and ductus arteriosus) are present in most patients with thoracic coarctation; this hypoplasia may be significant in symptomatic coarctation of the neonate and infant; in children and adults, the isthmus may have only mild narrowing. The transverse aortic arch (the arch between the origin of the right innominate artery and the left subclavian artery) is also hypoplastic in symptomatic neonates and infants. Collateral vessels that connect arteries from the upper part of the body to the vessels below the level of coarctation may be seen; these may be present as early as a few weeks to a few months of life.


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