E sign

Introduction Esophageal barium meal examination is often shown in the aortic constriction area, the enlarged thoracic descending aorta or the enlarged right intercostal artery after stenosis, and the pressure footprint formed on the left wall of the esophagus is called the "E" sign. For congenital aortic stenosis, the aortic lumen is small, only a few millimeters through the probe or diameter, located in the center of the diaphragm or on one side. The distal aortic wall of the narrowing segment often causes thickening of the intima layer due to blood flow impact.

Cause

Aortic coarctation is most common in adjacent sites where the arterial catheter or arterial ligament is connected to the aorta. The outline of the aorta of the constricted segment is inwardly depressed, but the aortic wall of the attachment of the arterial ligament is not obvious, or even slightly protruding. The narrowed section and its adjacent parts have obvious boundaries, and the length is generally within 1 cm. The distal portion of the aortic arch connected to the proximal end of the narrowed section is tapered and conical. The outer diameter of the descending aorta connected to the distal end of the constricted segment may be enlarged and the vessel wall thickened. The diameter of the aorta in the constricted section tends to be smaller than the appearance, and the middle layer of the aortic wall is thickened and protrudes into the lumen of the aorta to form a partition or a septum. The intima of the aortic wall is also hypertrophic.

The aortic lumen is small and can only be passed through the probe or the path is only a few millimeters, located at the center of the diaphragm or on one side. The distal aortic wall of the narrowing segment often causes thickening of the intima layer due to blood flow impact. The heart tends to increase and left ventricular hypertrophy is common. The middle layer of the coronary arteries is often thickened and the lumen is reduced, which may present symptoms of insufficient coronary blood supply earlier. Approximately 25 to 40% of cases have a double valve leaf type of aortic valve. The intercostal artery is obviously thickened, and the collateral circulation of the chest wall is abundant. In a few cases, the aortic arch branch can also be abnormal, such as left subclavian artery stenosis, right subclavian artery stenosis or right subclavian artery ectopic origin from the proximal or distal end of the narrowed aorta. Due to the increased blood pressure at the proximal end of the constricted segment, abundant collateral circulation and arterial enlargement, the intracranial artery, the proximal and distal aorta of the constricted segment, and the intercostal artery are prone to aneurysm, and its incidence increases with age. Big and rising. An aneurysm rupture can kill.

an examination

Related inspection

Cardiovascular angiography, echocardiography, cardiac vascular ultrasound

1. Aortic angiography can clearly define the location and length of the narrowing segment, the degree of aortic stenosis, the distribution of the ascending aorta and aortic arch branch, and whether it is involved, the collateral circulation of the blood vessels, and the fashion can show the patent ductus arteriosus. For typical cases of aortic coarctation, routine aortic angiography is not necessary, but for cases of narrowed lesions and long-segment aortic coarctation, the back can be heard as follows, and the rib notch is limited to one side or position. In the lower case, the data provided by aortic angiography facilitates the development of the surgical plan.

2, ECG examination: ECG changes depends on the severity of the lesions and hypertension and the length of the disease. ECG examination of childhood cases can be found without abnormalities, and older patients often show left ventricular hypertrophy and strain. And other patients with cardiovascular disease, can show double ventricular hypertrophy or right ventricular hypertrophy. Adult cases, such as electrocardiography, show myocardial damage or bundle branch block. Care should be taken to consider whether patients can tolerate surgery.

3, cardiac catheterization: through the femoral artery insertion catheter up into the descending aorta, if the narrowing section can be used to determine the proximal aortic pressure in the narrowing segment. Then, the catheter was slowly pulled out while continuously recording the aortic pressure. When the catheter passes through the narrowing section, the blood pressure immediately drops suddenly. There is a significant pressure difference between the upper and lower aortic pressures of the narrowing section, which can not only confirm the diagnosis, but also determine the severity of the narrowing lesion. Cardiac catheterization and cardiovascular angiography can provide important diagnostic data for other patients with cardiovascular disease. Two-dimensional echocardiography can also show aortic constriction lesions.

Differential diagnosis

It is to be distinguished from the annular narrowing of the ascending aorta. Their X-ray examination is similar to the signs displayed by an electrocardiogram. Annular narrowing of the ascending aortic roots Most cases of aortic stenosis appear in childhood. Because coronary atherosclerotic lesions occur earlier, angina is more common, and some patients have a family history. Aortic valve stenosis Most patients with aortic stenosis are adults, with no history of rheumatism. Heart murmurs are often found during physical examination.

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