When feeling sudden tearing-like chest pain, chest tightness and breath-holding, people must think that this is a coronary heart disease offense, maybe a large myocardial infarction. But there is another disease that is overlooked, and that is aortic coarctation. Aortic coarctation is one of the more common and most complex and dangerous cardiovascular diseases, with an incidence of 50-100 people/100,000 people per year, and its incidence is on the rise as people’s lives and dietary habits change. The natural prognosis of aortic coarctation is very poor, with a statistically reported mortality rate of 20% 15 minutes after onset. If left untreated and untreated, the mortality rate reaches 50% within the first 48 hours, and only 10% survive after 1 year, which is known as the “untimely bomb” in human body because it is so dangerous. In the 1980s, the famous American women’s volleyball attacker Hyman died suddenly on the field of play because of aortic coarctation. Therefore, timely diagnosis and proper treatment is the key to saving patients’ lives. Zhang Xiewei, Department of Vascular Surgery, The First Affiliated Hospital of Nanjing Medical University 90% of patients will experience sudden onset of severe pain in the precordial region, thoracic back, low back or abdomen during the acute onset of aortic coarctation aneurysm (intimal tear). The pain often occurs with certain sudden movements, such as lifting heavy objects, playing basketball and during abnormal excitement, and can be triggered by yawning, coughing and straining to defecate. The pain is like a cut or tear, radiating distally from the back of the sternum or the back of the chest along the aorta. Patients are often irritable, sweating profusely, feeling near death, or even fainting due to the pain. If the patient survives the acute phase, the chest and back pain may gradually disappear or turn into vague pain after a few days. In the general routine physical examination, patients with aortic coarctation may show significantly elevated blood pressure, usually systolic blood pressure can be as high as 160 mmHg or more, and some patients may have weakened or absent limb vascular pulsation and shock; chest X-ray examination can reveal aortic shadow is significantly widened, and some patients can be clearly diagnosed by ultrasound examination, and if CT scan examination of the aorta can be performed, it can better clarify the aortic coarctation If CT scan of the aorta can be performed, it can better clarify the diagnosis of aortic coarctation and provide very important information for further surgical treatment. The aorta is the thickest artery in the body, and after it emanates from the heart, it is called the thoracic aorta in the chest and the abdominal aorta when it reaches the abdomen. The aorta consists of three layers of tissue that are close together, called the intima, mesentery and epia. The so-called aortic coarctation is caused by various pathological factors that cause the aortic intima to tear, and gradually peel off under the impact of blood flow to form a coarctation, so that the aorta forms a “true cavity” and a “false cavity”, and blood flow enters the “false cavity” through the endothelial rupture. If the peeling is too severe or the pressure inside the “false lumen” is too high, the outer membrane of the aorta may expand in an aneurysmal manner, hence the name “aortic coarctation aneurysm”. Although aortic coarctation aneurysm has the title of “aneurysm”, it is actually very different from what we usually call “tumor”. A tumor is an abnormal proliferation of cells, often malignant, such as cancer; while aortic coarctation aneurysm is caused by abnormal expansion of the artery, it is neither malignant nor benign tumor, but its rupture and death is more dangerous than any tumor – just like a river breaking its banks during the flood season. The consequences are unimaginable, and the chance of successful resuscitation is very small, and death from hemorrhagic shock may occur within minutes. In addition, because the formation of aortic coarctation can affect the blood supply of important organs throughout the body, such as the heart, brain, internal organs, etc., it is also an important cause of death. Due to the relatively high incidence of thoracic aortic coarctation aneurysms and the absence of precursors, many patients die suddenly within two or three minutes of the onset of the disease, making it impossible to perform resuscitation. Therefore, if you have severe chest pain in daily life, you must go to the hospital for a comprehensive examination. Currently, non-invasive examinations are available through CT, MRI and ultrasound. It is important to be alert to the fact that thoracic aortic coarctation aneurysms are often misdiagnosed, mainly because patients with chest pain do not take it seriously and do not undergo relevant examinations, and are finally misdiagnosed as heart attack or angina pectoris, and when they wait until the onset of the disease, they can no longer be treated. Therefore, middle-aged hypertensive patients are reminded that if they have severe chest, abdominal and back pain and uncontrollable hypertension in daily life, they must go to the hospital for relevant examinations to avoid being misdiagnosed. Once aortic coarctation occurs also do not avoid excessive worry and go to the hospital to receive regular treatment. The surgery is minimally invasive and usually does not require an open chest, but only a small incision 3-4 cm long in the groin, and a stent with a membrane is placed in the aortic tear in a precise position to seal the fissure. The operation can be completed within 1 hour. At present, our department has been performing minimally invasive endoluminal treatment of aortic coarctation for 6 years and has successfully cured more than 200 cases. The volume and success rate of the operation are among the highest in China. The main causes of thoracic aortic coarctation aneurysms are hypertension and weakness of the middle membrane of the artery. Patients with poorly controlled hypertension, unstable blood pressure and young hypertensive patients are prone to this disease. Currently, there is a tendency for this disease to become younger, which is related to the high social pressure and the youthfulness of hypertension. Therefore, keeping a happy mood, good living habits and strict blood pressure control are the keys to prevent this disease.