Aortic coarctation is not rare, the incidence of the population is about 5-10 times per million people per year, the incidence of the last two years is on the rise, because the onset of aortic coarctation is very rapid, the mortality rate within 48 hours after the onset of death can reach 50%, within a week 70% of death, so it is called “the vascular bomb in the human body”, is a kind of It is a very dangerous disease. To understand aortic coarctation, we have to start with the anatomy of the human aorta. The aorta is the main artery of the body, and all the important branch arteries emanate from the aorta. The wall of the aorta has three layers of structure, from the inside out, the intima, the mesentery and the epima. The aorta is directly impacted by the blood flow pumped from the heart and its intima is subjected to tremendous blood flow pressure. Once the intima is broken under certain circumstances, the blood flow will enter under the intima from the broken area, causing the separation of the intima from the epima and thus forming an interlayer in the arterial wall, that is, a lumen that does not exist in the arterial wall – a false lumen. In the presence of elevated blood pressure, the strong blood flow pressure further tears open the intimal fissure of the artery, causing an expansion of the aortic coarctation. If the outer membrane of the aortic coarctation is also breached, the patient will hemorrhage and die immediately. The common age of onset is 45-70 years old, and the youngest patient reported so far is only 13 years old. The common causes of aortic coarctation are hypertension, atherosclerosis, and Marfan’s syndrome, among which hypertension and atherosclerosis are the most common causes. Patients with hypertension enter the age of prevalence of aortic coarctation 10-15 years after the onset of the disease. In recent years, the incidence of hypertension in our population has increased significantly and has reached 10%, with the number of patients reaching 120 million, and continues to grow at a rate of more than three million people per year. Moreover, there are two characteristics of our hypertensive population: first, the proportion of young patients has increased, and second, the number of patients with unstable hypertension has increased. This is the main reason why the incidence of aortic coarctation in China has increased significantly. Among hypertensive patients, those with fluctuating and uncontrolled blood pressure have an increased risk of aortic coarctation compared to those with stable and well-controlled blood pressure, and strict blood pressure control can effectively reduce the occurrence of aortic coarctation. In addition, high levels of estrogen and progesterone in pregnant women in late pregnancy can cause degeneration of the aorta and damage the structural integrity of the elastic fibers of the aortic wall, which can contribute to the development of aortic coarctation. Manifestations of aortic coarctation Patients with aortic coarctation often present with sudden onset of severe pain in the thoracic back, often accompanied by profuse sweating and difficulty breathing. This pain often progresses down the back and feels like it is tearing the skin, which is medically known as “tear-like pain” and is an important guide to the diagnosis of aortic coarctation. As the intima of the aorta tears, blood flows along the gap between the inner and outer layers of the vessel – the interlayer (false lumen) – and the original vessel lumen (true lumen) may be deflated by the false lumen, resulting in narrowing or occlusion of the lumen of the corresponding branch artery and the manifestation of insufficient blood supply to the corresponding organ: for example, obstruction of blood supply to the spinal cord may result in sudden paraplegia, and obstruction of blood supply to the kidney may result in sudden paraplegia. For example, obstruction of blood supply to the spinal cord may lead to sudden paraplegia, obstruction of blood supply to the kidneys may lead to anuria, and obstruction of blood supply to the internal organs may lead to abdominal pain; arterial entrapment may also develop around the rupture and tear into the carotid artery, which may lead to fainting or even coma due to insufficient blood supply to the brain; some entrapments tear into the root of the ascending aorta, the aortic valve or even the coronary artery, leading to heart failure or even cardiac arrest. At the same time, the pressure of blood directly acts on the outer membrane of the artery after the inner membrane is torn, and the aortic wall becomes very weak. If the blood pressure is too high, or if one coughs violently or even holds one’s breath when defecating, it can also lead to the rupture of the interlayer and death by hemorrhage. Diagnosis of aortic coarctation In recent years, various examination methods are very helpful to establish aortic coarctation, echocardiography, CT arteriography, aortic angiography, magnetic resonance can be used for diagnosis, and aortic angiography can be the best means of diagnosis and treatment for those considering surgery. CT arteriogram can clarify the location of the aortic coarctation and the size of the false lumen and the impact on vital organs. Treatment of aortic coarctation Aortic coarctation is a very dangerous disease with a high mortality rate and must be treated by surgery immediately once detected. Clinically, the treatment varies depending on the location of the aortic coarctation. Simply put, aortic coarctation with a rupture distal to the left subclavian artery is called type B aortic coarctation, while those with a rupture in the ascending aorta are called type A aortic coarctation. Type B coarctation: We can choose minimally invasive surgical endoluminal stenting. Under X-ray fluoroscopic surveillance, an appropriately sized aortic stent is introduced from the femoral artery to the site of the aortic dissection, and then the tubular stent is opened and fixed to the inner wall of the aorta, thus closing the intimal fissure. In this way, the blood flow in the aorta passes through the stent lumen and does not continue through the fissure into the false lumen, thus avoiding the risk of further development or even rupture of the entrapment. Instead, the residual blood in the false lumen of the arterial entrapment will gradually form a clot that will eventually transform into a fibrous scar. Many patients can eat the same night after surgery and can get out of bed the next day. The incidence of surgical complications and mortality rates are greatly reduced, enabling many patients who do not have the ability to tolerate traditional surgery to obtain effective treatment and prolong their lives. Type A entrapment: emergency surgery, which is very difficult. Because the rupture of aortic coarctation has accumulated the ascending aorta and the blood vessels of the brain, the conventional method is to do open surgery to replace the torn blood vessels with artificial blood vessels to eliminate the rupture of aortic coarctation, but because of the great difficulty of the surgery, there are not many large hospitals in Shanghai and even in the country that can complete it, and there may be many serious complications including paraplegia and cerebral infarction after the surgery, which brings great psychological and physical burdens to the patients and their families! This brings a great psychological and physical burden to patients and their families! In this winter season, we remind all patients, especially those with hypertension, to control their blood pressure, because the cold can cause an increase and instability of blood pressure, and to consult a doctor in time to be alert to the detonation of the “vascular bomb” in their bodies once they have sudden severe pain in the chest and back. If aortic coarctation is found and diagnosed, we should also pay attention to the following aspects during the period before and after surgery 1. Help the patient to turn over in bed, eat and drink frequently; have a reasonable diet, mainly light and easy to digest, eat more fruits and other vitamin-rich substances, and preferably eat more semi-liquid food. 2.Psychological aspect Pay attention to the patient’s emotional psychology, avoid anxiety, tension, pessimism and other negative emotions, chat more with the patient, resolve bad emotions, keep a happy mood, teach and patients the disease information and treatment care, help build their confidence, so that they actively cooperate with the doctor’s treatment, change passive acceptance to active participation. 3, blood pressure control Blood pressure should be monitored regularly on a daily basis, preferably once in the morning and once in the evening. High blood pressure and left ventricular contraction force and contraction rate will accelerate the stripping and expansion of aortic coarctation and aggravate the disease. Keeping blood pressure stable has important clinical significance for the treatment and recovery of the disease. When measuring blood pressure, the blood pressure of all four limbs should be measured at the same time, and the blood pressure of the healthy limb should be the real blood pressure as the standard for medication. 4.Emergency first aid In case of sudden severe pain or even shock, it is necessary to respond calmly and coolly. It is clinically found that 90% of patients will have severe pain like tearing in the chest and back at the beginning of the disease, and the pain will radiate along the periphery in the direction of entrapment separation, and the face becomes pale, the skin is wet and cold, sweating a lot, shortness of breath and rapid and weak pulse and other shock phenomena, at this time the key is to remain calm, help the patient to relieve pain, do not easily move the patient, keep him in a comfortable position posture, decompression and pain relief. Usually pay attention to observe the time, location and degree of pain to facilitate the use of medication. 5.Regular follow-up Do the follow-up of the disease and regular follow-up is very crucial for timely detection and control of the disease. 6.Take medication regularly as prescribed by the doctor Patients need to take medication regularly and do not adjust the dosage without authorization.