Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA.
Am J Cardiol. 2010 Oct 1;106(7):1038-41. doi: 10.1016/j.amjcard.2010.04.046.
The term "coarctation" necessarily calls attention to a specific morphologic abnormality of the aortic isthmus. However, in this report, the author seeks to dispel the simplistic notion that coarctation is best characterized by isthmic obstruction, which is only 1 of an assemblage of abnormalities that include the proximal paracoarctation aorta, the distal paracoarctation aorta, the ascending aorta, the transverse aorta, the coronary arteries, the conduit arteries (radial, brachial, and carotid), the retinal vascular bed, dissecting aneurysms, cerebral aneurysms, vascular rings, systemic hypertension, and a decrease in left ventricular interpapillary muscle distance. Some of these abnormalities are secondary to the coarctation, such as collateral arteries and dissecting aneurysms. Others frequently or invariably coexist but are not secondary, such as bicuspid aortic valve and aneurysm of the circle of Willis. Still other abnormalities are seemingly contradictory, such as aneurysmal dilatation of the low-pressure distal paracoarctation aorta, while the high-pressure proximal segment does not dilate significantly. In conclusion, coarctation should be regarded as an assemblage of cardiovascular abnormalities rather than as isolated obstruction of the aortic isthmus.
“缩窄”一词必然会引起人们对主动脉峡部特定形态异常的关注。然而，在本报告中，作者试图消除一种简单化的观念，即缩窄最好的特征是峡部阻塞，而这只是一系列异常中的一种，这些异常包括近段缩窄主动脉、远段缩窄主动脉、升主动脉、横主动脉、冠状动脉、导引导管（桡动脉、肱动脉和颈动脉）、视网膜血管床、夹层动脉瘤、脑动脉瘤、血管环、系统性高血压和乳头肌间左心室距离减小。这些异常中的一些是缩窄的继发表现，如侧支动脉和夹层动脉瘤。其他的则经常或普遍存在但不是继发的，如二叶式主动脉瓣和Willis 环动脉瘤。还有一些异常似乎相互矛盾，如低压远段缩窄主动脉的动脉瘤性扩张，而高压近段主动脉段并没有明显扩张。总之，缩窄应被视为心血管异常的集合，而不是主动脉峡部的孤立阻塞。
