coarctation of abdominal aorta
Introduction
Introduction to abdominal aortic coarctation In addition to abdominal aortic coarctation, the disease also has atypical aortic coarctation, abdominal aorta dysplasia, mid-aortic dysplasia, mid-aorticsyndrome and other names. basic knowledge The proportion of illness: the incidence rate is about 0.04% - 0.12% Susceptible people: seeing young men and women Mode of infection: non-infectious Complications: aneurysm heart failure
Cause
Abdominal aortic coarctation
Causes:
The cause of this disease is unknown. In view of the small age of some cases (the smallest is only 49 days), some people have proposed a congenital theory: there are two cases of dorsal artery absent with one of the two original tubes, and there are two fetuses. Dorsal aorta hyperfusion, there is a mitotic inhibition of vascular wall smooth muscle cells caused by viruses such as rubella, resulting in fetal or infant early aortic development discontinuation, and in view of the age of onset of some patients, combined with the pathology of diseased vessel wall There are non-specific arteritis or nodular arteritis, so some people hold the theory of acquired nature.
(two) pathogenesis
The disease can be divided into diffuse type, segmental type, the latter is divided into three types according to the location of the renal artery, the renal artery and the renal artery; the lesion can affect one or more visceral arteries in one or more places. The invaded artery can be narrowed or occluded. Some people have a case of a disease. The length of the lesion is from 4 to 16 cm, with an average of 7.6 cm. We have seen a case of only 2 mm long, which is a diaphragm-shaped deformity, which is rare (Fig. 1A, B). The histological manifestations of the lesions were normal, and there were also arterial intimal thickening, disordered fibrous tissue, and normal middle layer, intact elastic fibers, and people found "congenital rubella" in the elastic artery wall.
Prevention
Abdominal aortic coarctation prevention
Abnormal blood flow during embryonic period may be the main cause of aortic coarctation, so it should be noted in the prevention of this disease.
1. Vigorously promote prenatal and postnatal care, avoid viral infection in early pregnancy, reduce the influence of adverse physical and chemical factors in the uterus, and conduct prenatal genetics or chromosome examination if necessary to prevent problems before they occur.
2. Once the aortic coarctation is diagnosed, surgery should be performed regardless of symptoms.
Complication
Abdominal aortic coarctation complications Complications aneurysm heart failure
Can be combined with aortic aneurysm rupture, dissection, bacterial endocarditis, aortitis, heart failure and other complications.
Symptom
Abdominal aortic coarctation symptoms Common symptoms Hypotension Hypertension Lower extremity Blood pressure Low intracranial hemorrhage Inability to double vascular murmur Heart failure
The clinical manifestations of this disease vary depending on the pathological type and course of the disease. Malignant or refractory hypertension is the most common, most significant, and sometimes even the only clinical manifestation of the disease, but the lower extremity blood pressure is low or the femoral artery is not pulsating, others Table shows headache, diplopia, progressive encephalopathy, intracranial hemorrhage, heart failure and weakness of the lower limbs. The signs are abdominal audible and vascular murmur. The average age of the diagnosis is 21 years old.
Some people think that with a stethoscope (abdominal smell and vascular murmur), sphygmomanometer (measured upper limb hypertension and lower limb hypotension) and fingers (upper limb pulsation enhancement, lower limb pulsation weakened or even disappeared) can confirm the disease, but for a comprehensive understanding of the lesion Type, extent and other conditions of affected blood vessels, often require ultrasound, CT, MRI or angiography and other imaging examinations, especially angiography is important, imaging can show vascular stenosis in the lesion, stenosis to the proximal vessels and their branches expand, and The blood vessels become thinner from the stenosis, and the collateral vessels are dilated to supply blood to the stenosis.
Examine
Examination of abdominal aortic coarctation
1. The X-ray plain film has little or slight increase in heart. About 1/4 of the patients have a moderate to severe heart, the left ventricle is enlarged, hypertrophy, and the heart shadow is aortic or intermediate.
2. ECG over 1 year old, 71% left ventricular hypertrophy, 14% double-chamber hypertrophy, only 3% simple right ventricular hypertrophy, and the other 12% normal.
3. Echocardiography transthoracic echocardiography has a good sensitivity for the diagnosis of aortic coarctation. Two-dimensional echocardiography can be used to detect the long axis of the aortic arch and to determine the aortic coarctation. Location and length.
4. CT and MRI use contrast enhancement to continuously scan the aortic arch, which can show the location of aortic coarctation. MRI is suitable for showing the relationship between the lumen of the thoracic aorta, the wall and the left subclavian artery, and the surrounding soft tissue structure. Such as morphological changes.
Diagnosis
Diagnosis and differentiation of abdominal aortic coarctation
Young patients with this disease need to be differentiated from arteritis. Older patients need to be differentiated from atherosclerotic disease. In addition to clinical and laboratory results, they should be identified based on histopathology.
