Old Master Li is a cab driver, 47 years old, one evening, when driving suddenly felt a sharp pain in the chest before the heart, because of the past history of angina, they usually carry life-saving pills – nitroglycerin tablets, so, after the onset of chest pain rushed to mouth a piece, but did not see the previous effect, so rushed to have people sent to The emergency electrocardiogram only indicated myocardial ischemia, and the myocardial enzyme profile was not high, so no evidence of angina could be found. During this period, the doctor asked him to take a piece of nitroglycerin by mouth again, but it was still ineffective, so the doctor asked Master Li’s chest pain again carefully, and then prescribed an emergency CT examination, which revealed that Master Li’s original disease was not in the heart, but in the thoracic great vessels – thoracic aorta, and the disease name was acute aortic coarctation, so he was transferred to our department for follow-up treatment. What is aortic coarctation “coarctation” literally simple, most ordinary people can understand, but the aortic coarctation is not simple, even doctors, if non-related professional, it is estimated that many people do not know much about this disease. So what is aortic coarctation? The aorta is one of the thickest arteries in the body, emanating from the heart as the thoracic aorta and extending to the abdomen as the abdominal aorta. The wall of the aorta can be divided into three layers: the outer membrane, the middle membrane and the inner membrane, which are constantly subjected to the impact of high speed and high pressure blood, thus ensuring the blood supply to all organs of the body. If there is a weak link in the aortic wall, especially in the middle and inner membranes, the constant impact of blood may tear the inner membrane into the middle membrane and tear the distal extension, causing the aortic wall to separate into a new lumen, so that one tube becomes two tubes and aortic coarctation is formed, professionally called the new lumen as a false lumen, while the original lumen is called the true lumen. What are the risks? The aorta is the thickest primary blood supply tract in the body, and once a coarctation occurs, there are only two consequences: bleeding and ischemia. The first is bleeding. After the formation of aortic coarctation, the blood flow in the false lumen continues to impact the outer membrane, and the pressure inside the false lumen is often higher, so the outer membrane is prone to rupture and hemorrhage; however, there are often multiple fissures between the real and false chambers of aortic coarctation, and this traffic relieves the high pressure inside the false lumen to a certain extent, and although rupture and hemorrhage may still occur, the reduced pressure inside the false lumen will help many patients survive the In the chronic phase, the pseudocavity tends to expand continuously, therefore, there is still a possibility of rupture of the aortic coarctation in the chronic phase, and the current medical technology cannot accurately predict when it will rupture, because of this, some people have imaginatively compared aortic coarctation to “an untimely bomb in the human body”. Whether in the acute or chronic stage, once a rupture occurs and causes hemorrhage, the success rate of treatment is extremely low, which is basically equal to the death sentence of the patient. The aortic coarctation tear site can involve the blood supply arteries of several organs in the body, such as coronary artery, carotid artery and vertebral artery, intercostal artery, celiac artery, superior mesenteric artery, renal artery and limb artery, which can lead to ischemia or even necrosis of the corresponding target organs, such as heart, brain, spinal cord, liver, spleen, small intestine, kidney and limb, and in serious cases, the failure of several organs in the body can occur. The patient’s life can be endangered. In short, once the onset of aortic coarctation, the condition is very dangerous, whether bleeding or ischemia, can endanger the lives of patients, according to statistics, the disease within 24 hours of the onset of mortality rate of 25%, after 48 hours up to 50% or more. China’s famous male volleyball player Zhu Gang and American female volleyball player Hyman are suffering from this disease, but still died after rescue, which shows the danger of its condition. Disease Identification There are many causes of chest pain. In addition to aortic coarctation, cardiac lesions such as angina pectoris or myocardial infarction, respiratory diseases such as pneumonia, some digestive diseases with atypical symptoms, surgical diseases such as chest wall trauma and costochondritis, and cardiac neurosis can cause it, but chest pain due to aortic coarctation is usually special and consistent with its pathogenesis, and typical patients with coarctation often present “tearing pain”, the pain site is mostly in the posterior sternum, precordial area or lumbar back, can radiate to the head and neck, upper limbs, abdomen and lower limbs, etc. The pain is severe, heavy with a sense of near death, and lasts for a long time. It is not difficult to differentiate between typical symptoms and other diseases, but the diagnosis still needs further examination such as MRI or CT, especially angiography is preferred; for patients with atypical symptoms, especially if “heart pain” and “vascular pain” cannot be differentiated, MRI or CT should also be performed. For patients with atypical symptoms, especially if “heart pain” and “vascular pain” cannot be distinguished, MRI or CT should also be performed, because after all, there are few cases of death due to misdiagnosis of “vascular pain” as “heart pain”. Most patients with aortic coarctation have hypertension. Although it is not clear whether the relationship between the two is chicken and egg or egg and chicken, one thing is certain: hypertension can contribute to aortic coarctation, so for people with hypertension, blood pressure should be controlled. Although prevention is better than cure, that is all the preventive measures we can do in terms of the current medical level. After the acute onset of aortic coarctation, blood pressure should first be strictly controlled to ensure that it is stable within the normal range, and in particular, it should be done so that it does not fluctuate too drastically. Analgesic sedation should be given to those with severe pain to reduce the patient’s irritability. Surgical treatment is the only effective way to cure aortic coarctation. The traditional surgical method is to remove the diseased section of the aorta after opening the chest and replace it with an artificial vessel, often requiring extracorporeal circulation, which is highly invasive and sometimes even requires open abdomen, with high complication and mortality rates. In this way, blood flows distally through the stent without entering the false lumen, effectively avoiding the risk of rupture, and the false lumen will slowly heal itself later. This method is the first choice for the treatment of aortic coarctation because of its small trauma, low complication rate, short hospitalization time, and quick recovery after surgery, which greatly reduces patients’ pain. Internationally, Prof. Dake completed the world’s first case of intracavitary isolation of aortic coarctation in 1994, while in China, Prof. Jing Zaiping, the supervisor, was the first to carry out this technique in 1998, and has completed more than 400 cases so far, which is the leading level at home and abroad. After Master Li was transferred to our department, we introduced his condition and treatment methods to him and his family in detail, and they did not hesitate to choose endoluminal isolation, and the operation was very successful. The “untimely bomb” was eliminated, and Master Li smiled happily when he was discharged from the hospital. Suggestions Chest pain is not always “heart pain”, should also be alert to the “vascular pain” caused by aortic coarctation. “Heart pain” must be treated heart, “vascular pain” is to be treated blood vessels, the two treatment methods are very different, therefore, when there is disease must be as soon as possible to the regular hospital specialist consultation, so as to avoid misdiagnosis and mistreatment to the greatest extent.