Coarctation of the Aorta

Abstract

The relatively bad prognosis in cases of aortic coarctation seemed to. be sufficient ju'stification for making an attempt at surgical treatment in these patients. One of us (Crafoord), during work with patent ductusarteriosus and as the result of both experimental and-clinical 'studies of the circulatory conditions existing when the aorta is shut off at differentlevels, gradually came to the conclusion that the surgical risk would not be too-great. In experimental studies on dogs, Crafoord (1939) demonstrated that the flow of blood to all the organs could remain suspended for as long as twenty to twenty-five minutes without any subsequent sign of organic damage, provided an' adequate flow to the brain was secured. This circulation to the brain -was maintained by creating anastomoses between the carotid and jugular vessels on one side in the animal under operation with the corresponding vessels in a dog of the same size lying beside it. On the strength of this observation Crafoord toQk the risk, in certain patients with a patent ductus arteriosus, of placing clamp forceps on the aorta above and below the point of entry of the duct into this artery and of keeping them attached during the time necessary to divide the duct and suture the aorta. In one of the patients this part-of the operation took no less than 27 minutes to perform. In spite of this long period, during which the aorta was shut off just below the point where the subclavian artery arises, no noticeable disturbances were subsequently observed in the patient's internal organs. As far as we -have been able to ascertain from the literature, the only other investigator besides Crafoord who has considered the possibility of relieving coarctation of the aortic isthmus by a surgical intervention is Blalock (Blalock and.Park, 1944; Blalock and Taussig, 1945). The latter, however, approached the problem .in. a more conjectural manner and from a different standpoint, having considered some fo'rm of anastomosing operation or plastic reconstruction