Coarctation of the aorta. A risk factor in children for the development of arteriosclerosis.

Pressure recordings in 120 patients, aged 0-35 years, undergoing operation for coarctation of the aorta, show a slow but steady rise in both systolic and diastolic peak pressures, the highest peak registered being in patients aged 16-18 years. The finding of significant morphological changes in the aorta in this age group is the rule and these arteriosclerotic changes become more severe as the patients get older. In long-standing coarctation, the degree of mineralisation proximally is up to 10 times higher than distally. The microscopic and ultrastructural changes in the proximal segment are essentially arteriosclerotic. In conclusion, the role of coarctation of the aorta in the pathogenesis of arteriosclerosis is essentially that of hypertension, a most important risk factor of arteriosclerosis. Since arteriosclerosis also develops in the region of low blood pressure, other factors are operative. We suppose that the reduced pulse and volume pressures, which in turn diminish the "windkessel" function of the aorta may effect a change in the blood flow patterns to favour the development of arteriosclerosis.