Author: Prof. Shu Chang, Qing Xue, Department of Thoracic Surgery, Shanghai Changhai Hospital
Source: Medical Cardiovascular Channel
1. What is aortic coarctation?
The aorta is the thickest trunk vessel in the human body, emanating directly from the heart and subject to strong pressure directly from the heart pumping blood, and it has a huge internal blood flow. The normal human arterial vasculature consists of 3 layers of structures, divided from the inside out into the inner membrane, the middle membrane and the outer membrane, and the 3 layers fit closely together to carry the blood flow through. In the case of aortic coarctation, the endothelium is ruptured and the middle layer is gradually peeled off after a strong impact of blood, so the aortic wall is peeled off to form a coarctation structure, resulting in tear-like pain as the main manifestation.
2. Why is aortic coarctation a cause for concern?
Due to the tremendous pressure and blood flow in the aorta, once the aortic vessel wall is torn, the chance of rupture leading to hemorrhage is very high and the mortality rate is extremely high. According to the literature, without timely management, 3% of patients will suffer sudden death, death within two days accounts for about 37%-50% or even 72%, and mortality within a week is as high as 60-70%!
In developed countries in Europe and the United States, aortic lesions are dominated by dilated diseases such as aortic aneurysms, while in China aortic coarctation accounts for the majority of cases, and the incidence of aortic coarctation has a tendency to be younger in recent years.
The ratio of male to female incidence of aortic coarctation is 2-5:1; the common age of onset is 40-70 years old, but congenital cardiovascular disease patients with aortic coarctation occur at a younger age, such as patients with Marfan syndrome often develop in young and middle age.
3. What are the causes and risk factors of aortic coarctation?
What kind of people are prone to aortic coarctation? That is, what are the etiology or causes of aortic coarctation?
Aortic coarctation is the result of the interaction of aortic vessel wall lesions and abnormal blood flow pressure. On the one hand, when the aortic vessel wall is structurally abnormal, it is naturally prone to aortic dissection, and on the other hand, abnormal hemodynamics predispose the arterial wall to damage.
The American Heart Association AHA risk factors for the development of aortic coarctation published in the journal Circulation are: hypertension, atherosclerosis, congenital cardiovascular malformations, Marfan syndrome, diastolic malformations, Loeys-Dietz syndrome, Ehlers-Danlos syndrome, aortic trauma and medically induced injury, inflammatory or infectious aortic lesions, and pregnancy. Patients with any of these risk factors should be alert for the development of aortic coarctation.
4. How to recognize aortic coarctation?
A typical acute aortic coarctation presents with sudden, severe, tear-like pain in the chest and back, and in severe cases, heart failure or even sudden death; and most patients have a history of hypertension. Depending on the extent of the tear, different branch arteries of the aorta may tear, with different clinical manifestations, such as ischemia of the brain, limbs, kidneys and organs such as the liver and intestines, which can lead to ? infarction , renal insufficiency, abdominal pain, pale legs, weakness, florid spots, paraplegia, etc. If the entrapment involves the coronary artery or breaks into the pericardium, myocardial infarction, pericardial tamponade or even sudden death may occur. Therefore, aortic coarctation is a disease that can lead to the failure or necrosis of all vital organs in the body, and the clinical manifestations vary from person to person and are very dangerous.
In order to confirm the diagnosis of aortic coarctation, the most widely used and accurate clinical examination is CTA. In case of sudden onset of chest and back pain, you should go to the hospital for examination as soon as possible.
5. What should I do if I suffer from aortic coarctation?
If you are unfortunate enough to suffer from aortic coarctation, you should not give up completely on resuscitation, as aortic coarctation is not an incurable disease. The treatment for aortic coarctation mainly includes medication, interventional therapy and surgical treatment.
For patients with acute entrapment, no matter what further treatment we want to take, first of all, strict pharmacological treatment should be carried out: blood pressure control, heart rate control, and pain control.
After the patient has been appropriately stabilized, the choice of treatment depends mainly on the type of entrapment. For Stanford type A aortic coarctation with a rupture in the ascending aorta and aortic arch, early open-heart aortic replacement surgery is required, which is more traumatic and slower to recover.
For Stanford B aortic coarctation with the rupture in the descending aorta, minimally invasive stent implantation is the main method to seal the rupture and restore blood flow to the organs by introducing a stent into the peripheral vasculature, which is less invasive and has a faster recovery. At present, with the continuous advancement of endoluminal minimally invasive surgery technology, aortic arch entrapment can also be treated minimally invasively by advanced technologies such as chimney technology, open window technology and branch stenting, which is especially suitable for patients who are old and have high risk of open heart surgery.
Again, it should be reminded that regular review and blood pressure and heart rate control are crucial for both open-chest surgical treatment and minimally invasive stent repair. By lowering blood pressure and reducing heart rate to reduce the impact of blood flow fluctuation waves on the aortic wall, the occurrence of aortic coarctation, rupture, and recurrence after surgery can be effectively prevented.
http://mp.weixin.qq.com/s?__biz=MjM5OTc3NTcxMw==&mid=401874385&idx=2&sn=08a8e41820571dd6f0b13074a0c59806&scene=0#wechat_redirect