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Ann Thorac Surg 1976;22:66-73
© 1976 The Society of Thoracic Surgeons

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Articles

Preferential Atherosclerosis at the Aortic Junction of the Ligamentum Arteriosum: Clinical Significance and Pathological Correlation

Departments of Cardiac and Thoracic Surgery and of Pathology, Vanderbilt University School of Medicine, Nashville, TN

^* Address reprint requests to Dr. Bender, Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232

Clinical experience with 5 patients who had complications of atherosclerosis within the aorta at the site of the obliterated ductus arteriosus suggested the occurrence of clinically significant preferential atherosclerosis at this location. To examine this hypothesis, the clinical findings in these patients (4 with saccular aneurysm and 1 with systemic emboli from an ulcerated plaque at this location) were correlated with postmortem examination of the aortic isthmus in 40 consecutive cadavers.

The point of ductal closure was the area of most severe atheromatous involvement in 32 of the 40 cadavers, and 25 of the 40 specimens demonstrated ulcerated plaques at this location. Microscopical examination consistently demonstrated intimal irregularity or disruption and thinning of the aortic media in this area. These studies indicate that preferential atherosclerosis occurs at the aortic end of the obliterated ductus arteriosus and that these atherosclerotic changes can be a clinically significant development.