Perinatal vascular changes in coarctation of the aorta with distal patent ductus arteriosus.

PULMONARY vascular changes often help to explain the circulatory abnormalities that develop in certain persons with congenital cardiac anomalies. Although such vascular changes have been described in some persons with coaretation of the aorta and distal patent ductus arteriosus,1-5 the cause of the pulmonary hypertension in other cases has remained obscure." 6 None of the reported studies of this type of coaretation has included quantitative comparisons of the two major circulatory beds. Such a study should provide useful information about the genesis of the high pulmonary vascular resistance in these cases. Circulatory abnormalities in this disorder may alter the development of the vascular beds both before and after birth. Before birth, pressures in both sides of the heart may be elevated, as evidenced by the biventricular cardiac hypertrophy found in newborn infants with these anomalies." 7, 8 After birth, since the ductus arteriosus remains patent, the lesser circulation and most of the greater circulation are subjected to a common pressure through a common ejectile force.3 Under these circumstances, at least part of the pulmonary vascular resistance and pulmonary arterial muscle mass developed during fetal life may be retained." 3 4 The current report offers information regarding an abnormal development of the pulmonary vascular bed before birth in such cases. In addition, neonatal changes in both the greater and lesser circulatory beds are quantitated.