Summary
After repair of coarctation of the aorta using the technique of resection and end-to-end
anastomosis, the internal diameters of the aortic isthmus and descending aorta often
fail to increase. Better results seem possible with aortoplasty using the left subclavian
flap technique. In order to clarify this matter, we investigated the structure of
the left subclavian artery comparing it with that of the descending aorta and aortic
isthmus: we studied the internal diameter, the thickness of the tunica media and the
packing density of its elastic fibers in these vascular elements using a postmortem
material of children with a coarctation of the aorta. The ages ranged from 4 days
to 13 months with one child of 8 years. All 16 cases had one or more additional cardiac
lesions. Operation had been performed in 3 children: 2 end-to-end anastomoses and
one subclavian bypass of the aortic arch. Data were compared with observations on
autopsy cases of children without cardiovascular abnormalities. The mean findings
were that the calibers of the left subclavian artery and the descending aorta were
within normal limits but that the caliber of the aortic isthmus was smaller than in
normal children.
The measurements on the tunica media showed that although, generally, the thickness
of the media of the left subclavian artery was smaller than that of the aortic isthmus
and descending aorta of the same individual, it contained relatively more elastic
fibers than the matching vessels. This may indicate that the structure of the left
subclavian artery is well suited to grow out as a part of the aortic arch. This may
- at least in part - explain the fact that the left subclavian flap technique seems
to give a lesser degree of recoarctation than end-to-end anastomosis after resection.
Key words
Subclavian flap - Histo-anatomical backgrounds
