Aortic sinus rupture

Introduction Aortic sinus aneurysm rupture, also known as rupture of the sinus sinus tumor, is due to the lack of normal elastic tissue and muscle tissue in the aortic sinus wall, which is impacted by high-pressure blood flow, gradually forming a saccular tumor, which protrudes outward and eventually causes rupture. . This disease is a rare congenital heart disease. The incidence of this disease is high in adults, and the condition suddenly appears and develops rapidly. Clinical manifestations mainly include sudden and severe chest pain, palpitations, shortness of breath, and easily lead to heart failure. The curative effect of this disease is exact, the operative mortality is low, and the normal heart function can be completely restored after operation, but the mortality of severe heart failure is high and the postoperative recovery is slow. Therefore, early surgery should be performed.

Cause

The main cause of rupture of aortic sinus aneurysm is the lack of normal elastic tissue and muscle tissue in the aortic sinus wall. It is impacted by high-pressure blood flow, gradually forming a saccular tumor, which protrudes outward and eventually causes rupture. This disease is a rare congenital heart disease.

Congenital heart disease is mainly caused by the disturbance of the fetal heart during development, causing some developmental pauses or defects, and some of the degenerative people are not completely degraded.

First, the fetal environment factors: early pregnancy virus infection, more common after rubella virus infection, often cause patent ductus arteriosus and pulmonary stenosis, followed by Coxsackie infection (Coxsakie) can cause endocardial elastic fiber Hyperplasia, in addition to amniotic membrane disease, mechanical compression around the fetus, maternal dystrophy, vitamin deficiency and metabolic diseases, maternal cytotoxic drugs or longer-term radiation exposure, may be related to the occurrence of this disease.

Second, genetic factors: 5% of patients with congenital heart disease occur in the same family, the disease is the same or similar, may be due to genetic abnormalities or chromosomal aberrations.

Third, other: high incidence of patent ductus arteriosus and atrial septal defect in the plateau area, the occurrence may be related to hypoxia. Some congenital heart disease is gender-oriented.

an examination

Related inspection

Electrocardiogram, blood pressure, dynamic electrocardiogram (Holter monitoring), angiography

Symptoms and signs

Symptom

Half of the patients presented with chronic progressive heart failure, and approximately one-third of patients had acute chest pain and acute heart failure. Some patients have a long history of fever.

2. Physical examination

The IV-V continuous mechanical murmur between the 3~4 ribs of the left sternal border is the loudest in the middle of the contraction. The pulse pressure difference increases, and there may be water impulses and capillary pulsation signs.

Diagnostic examination

Electrocardiogram

Most of the right ventricular hypertrophy with strain or left ventricular hypertrophy with strain.

2. X-ray inspection

The lungs are congested and the heart shadow is enlarged. Retrograde aortic angiography clearly shows that the sinus tumor has broken into the heart chamber.

3. Echocardiography

It can be seen that the enlarged aortic sinus often has aortic regurgitation. Most of the visible sinus tumors broke into the heart cavity, pay attention to the presence or absence of sputum.

Differential diagnosis

Congenital aortic stenosis: (1) ascending aortic root ring narrowing (2) aortic valve aponeurosis stenosis (3) long ascending aortic dysplasia.

In most cases, the symptoms of aortic stenosis appear in childhood. Because coronary atherosclerotic lesions occur earlier, angina is more common, and some patients have a family history. Aortic stenosis, especially in cases with mental retardation, special face and extensive stenosis of the pulmonary artery. Often in the early years due to severe obstruction of the left ventricular outflow tract and coronary artery disease, sudden death, rarely treated, rarely grow into adulthood.

Aortic sacral stenosis: Aortic stenosis is the rarest in congenital aortic stenosis, accounting for about 5 to 10%. Male and female incidence rates are similar. Stenosis of the stenosis may be accompanied by mental retardation. The stenotic lesion is located above the opening of the coronary artery. Aortic stenosis lesions are more common, accounting for about 90%. Signs are similar to other types of aortic outlet stenosis, but no systolic clicks are heard. The location of heart murmurs and tremors is higher than that of the stenosis of the valve, and aortic diastolic murmurs are rare.

Some patients have poor growth and development, short stature, low intelligence, many words, and have a special face: mandibular retraction, nostril leaning forward, low nose bridge, thick lip, wide forehead, large eye distance, poor tooth occlusion. About 5% of patients have elevated blood calcium.

Aortic ring dilation: the proximal aorta and aortic roots widen, leading to aortic regurgitation. Thoracic aortic aneurysms are usually seen on chest X-rays. CT and MRI are particularly helpful in confirming the extent and size. Transthoracic ultrasound can accurately measure the size of the ascending aortic aneurysm, but not for the descending aorta. Esophageal ultrasonography can accurately measure both. Most of the indications for thoracic aortic aneurysm before resection are aortic contrast angiography or magnetic resonance aorta angiography.

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