What is the role of associated anomalies in the pathophysiology 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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Associated anomalies greatly influence pathophysiology. [11] VSD is frequently present, and coarctation exacerbates the associated left-to-right shunt. Other levels of left heart obstruction (aortic stenosis, subaortic stenosis) may be present and may add to LV afterload.

Numerous neurohumoral changes occur with CHF. [12] Sympathetic nervous system activation occurs, resulting in increases in heart rate and blood pressure (BP). The renin-angiotensin system is activated in patients with CHF, particularly in coarctation of the aorta, in which lower-body BP and renal perfusion may be reduced. Activation of the renin-angiotensin system results in vasoconstriction, cell hypertrophy, and the release of aldosterone. The role of the renin-angiotensin system in CHF and the use of drugs to modulate this system are an intense area of research. Unlike most cases of CHF, coarctation of the aorta is more complex because precoarctation and postcoarctation hemodynamics are quite different.

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