Aortic coarctation is a disease in which the inner lining of the artery looks torn and is impacted by blood flow, peeling off the inner lining and forming two chambers, thus causing symptoms such as tear-like giant pain in the back of the chest and ischemia of internal organs. It used to be called aortic coarctation aneurysm, but is now mostly referred to as aortic coarctation. Schematic diagram of aortic coarctation in surgery Aortic coarctation is a dangerous condition that can lead to death directly after rupture. It has been reported that 24% of patients with acute aortic coarctation die before admission and 68% die within 1 week! It is a veritable demon of life! So what kind of causes predispose to aortic coarctation? The most common cause is hypertension. More than 80% of patients with aortic coarctation have hypertension, and almost all patients with aortic coarctation have poorly controlled hypertension. Clinical and animal studies have found that it is not the height of blood pressure but the magnitude of blood pressure fluctuations that is associated with split aortic coarctation. Cystic middle aortic necrosis is quite common in the hereditary disease Marfan syndrome, and the chance of aortic coarctation is high. The clinical manifestations of aortic coarctation include some of the following: 1. Typical patients with acute aortic coarctation often present with sudden, severe, tear-like or knife-like pain in the thoracic back, and severe heart failure, syncope, or even sudden death; most patients also have uncontrollable hypertension; 2. Occlusion of branch aortic arteries can lead to corresponding ischemic symptoms in the brain, abdominal organs, and limbs: such as cerebral infarction, oliguria, abdominal pain, pale legs, weakness, florid spots, and even paraplegia; 3. In addition to the above main symptoms and signs, other conditions include: loss of peripheral arterial pulsation, vocal cord paralysis, and the involvement of the mesenteric artery and renal artery by the entrapment may cause signs such as intestinal paralysis and even necrosis and renal infarction. Pleural effusion is also a common sign of aortic coarctation, mostly on the left side. The main auxiliary tests to confirm the diagnosis of aortic coarctation are: CT angiography (CTA) and magnetic resonance imaging (MRA). CT angiography (CTA) is currently the most commonly used imaging evaluation method, and CTA tomography allows the observation of an entrapped septum dividing the aorta into true and false lumens. Reconstructed images provide two- and three-dimensional images of the entire aorta. Its main disadvantage is that iodine-containing contrast agents are injected, and a small percentage of patients are unable to undergo CTA due to iodine allergy. The enhancer used in magnetic resonance examination (MRA) is not nephrotoxic; its disadvantage is that it takes longer to scan and is not suitable for emergency patients with unstable circulatory status or for patients with magnetic metal implants in the body. Few hospitals are currently performing this procedure. Once the disease is suspected or diagnosed, the patient should be hospitalized for supervised treatment. Treatment is divided into pharmacological and surgical treatment. 1.Medication The main treatment includes blood pressure control and pain relief. First of all, it should reduce the myocardial contraction, slow down the left ventricular contraction speed and peripheral arterial pressure. The goal of treatment is to keep the systolic blood pressure around 100 mmHg and the heart rate 60-75 beats per minute. This effectively stabilizes or aborts the continued separation of the aortic coarctation, resulting in relief of symptoms and disappearance of pain. Painkillers can be applied appropriately to help relieve pain. 2.Surgical treatment Surgical treatment can be taken after the patient’s condition is properly stabilized. Surgical treatment is mainly divided into aortic replacement surgery and aortic endoluminal treatment (commonly known as overlapping stent implantation). The choice of surgical method is mainly based on the extent of aortic coarctation involvement. As far as the current treatment status is concerned, for aortic coarctation not involving the ascending aorta, endoluminal treatment of the aorta is the main treatment, often called overlapping stent implantation, which has the advantages of small surgical trauma and fast postoperative recovery, but the disadvantage is that the treatment cost is relatively high. Diagram of overlapping stent implantation Intraoperative image of overlapping stent implantation Before overlapping stent implantation After overlapping stent implantation For aortic coarctation involving the ascending aorta, urgent ascending aortic replacement under extracorporeal circulation is required. The procedure is very traumatic and risky, and the postoperative recovery is slow. Only a few hospitals currently perform this type of surgery. It is important to note that regular follow-up after surgical treatment as well as blood pressure and heart rate control are crucial. Strict follow-up can detect changes in the condition and deal with them in time; lowering blood pressure and reducing the contraction rate of the left ventricle can reduce the impact of blood flow fluctuation waves on the aortic wall, which can effectively prevent the recurrence of aortic coarctation and the emergence of postoperative complications.