Treatment of aortic coarctation aneurysms

  There are non-surgical and surgical treatments.  1.Non-surgical treatment is applied to acute cases, once the main artery entrapment aneurysm is suspected, it is given immediately, the purpose of which is to prevent the expansion of the entrapment hematoma. Because the clotted hematoma keeps expanding, it can compress important organs, cause ischemia and dysfunction of organs, rupture of the hematoma outward, etc. This is bound to seriously endanger the patient’s life, so the systolic pressure and ventricular ejection velocity must be reduced to reduce the provocative effect on the aorta. Jiang Xionggang, Department of Cardiac Surgery, Wuhan Union Hospital (1) Pain relief: Dulcolax or morphine can be given intravenously. Because the drug has side effects such as inhibition of respiration, it should be applied by internal medicine physicians.  (2) Hypotension: lower the systolic blood pressure to below 13.3~16.0kPa (100~120mmHg) as soon as possible, and use sodium nitroprusside intravenously to reduce cardiac afterload and hypotension, but attention should be paid to adjust the drip rate in time according to the blood pressure control level. In addition, beta-blockers, such as betalactone and insulin, can be given to reduce myocardial contractility and slow down the heart rate. Pain relief is an indicator of the cessation of the development of the entrapped aneurysm and the efficacy of the treatment. Aortography is feasible only after the pain is relieved.  2.Surgical treatment of aortic coarctation aneurysm has a high morbidity and mortality rate in the acute phase (within 6 weeks). The morbidity and mortality rate is about 70% for proximal coarctation medical treatment and 30% for surgical treatment. The rate is 20% in the group treated medically and 50% in the group treated surgically for distal coarctation. The recurrence rate in the medical treatment group is higher than that in the surgical group, so if the conditions are suitable, surgical treatment should be chosen for distal entrapment. Regardless of non-surgical or surgical treatment, after successful resuscitation, one should continue to take antihypertensive drugs and drugs that weaken myocardial contractility to prevent recurrence, such as β-blockers, to control systolic blood pressure below 17.3 kPa (130 mmHg) to avoid further splits.