What is the pathogenesis 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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The exact mechanism by which aortic coarctation is produced is not clearly understood. The most commonly invoked hypotheses include hemodynamic and ectopic ductal tissue theories. In the hemodynamic theory, an abnormal preductal flow or abnormal angle between the ductus and aorta that increases right-to-left ductal flow and decreases isthmic flow potentiates development of coarctation. Postnatal spontaneous closure of the ductus arteriosus completes the development of aortic obstruction. [2, 3]

A high incidence of coarctation of the aorta in patients with congenital heart defects with decreased antegrade aortic flow in utero and virtual absence of CoA in patients with right heart obstructions lends credence to the hemodynamic theory. Abnormal extension of ductal tissue into the aorta (ectopic ductal tissue). [4, 5] has been postulated to create the coarctation shelf and, with ductal closure, development of aortic obstruction. This theory, however, does not explain the variable degrees of isthmus and aortic arch hypoplasia associated with coarctation of the aorta.

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