Aortic Aneurysm - is limited intraluminal aortic dilatation of the vessel is localized in any of its anatomical parts and are resistant clinical manifestations.A separate disease entities in the international classification of cardiac dissecting aortic aneurysm, which is a complication of the main disease that occurs when its long-term course or a traumatic injury.
There are many clinical, etiopathogenic and morphological classifications of aortic aneurysm, however, the fundamental criterion for practicing cardiology and cardiac surgery is the division of the localization principle aneurysmal expansion.
reasons aortic aneurysm
a long time the only etiopathogenetic factor that provokes the development of aortic aneurysms, atherosclerotic vascular lesions was considered, but now there are many pathogenic theories of the formation of aneurysmal aortic enlargement.
Aortic aneurysm of the heart often develops as a result of "defective" tunica media of the vessel wall, whic
Recent scientific studies on the pathogenesis of aortic aneurysms, a fact proved negative impact of non-specific degenerative processes occurring in the middle of the vascular wall shell that cardiac surgery is termed "medionekroz."These pathological changes of the vascular wall of the aorta are observed in patients suffering from generalized disorders of connective tissue that is observed in Marfan's disease.
Acquired aortic aneurysm is often the result of an inflammatory disease of the aortic vessel infectious and immune nature, that there is, for example, in syphilis.The principal difference from aneurysmal aortic aneurysm expansion and other vessels is that the aneurysmal sack in aorta projection consists exclusively of the fibrous component and there is absolutely no evidence of a laminar flow.Due to the fact that when the aortic aneurysm in a lumen of the aneurysmal sac formed massive thrombotic layers, even when the angiographic contrast study is not possible to reliably estimate the metric parameters of the aneurysm.
Fortunately, in recent years began to meet less frequently aneurysms arising as a complication of surgery on the aorta, but abdominal aortic aneurysm often have post-traumatic genesis that occurs in a closed blunt abdominal trauma.
Symptoms of aortic aneurysm
specificity of clinical symptom, as well as the intensity of the manifestation of certain symptoms depends on the aneurysmal localization of vascular lesions, as well as on the size of the aneurysmal sac.Long for aneurysms inevitably provokes an increase in its metric parameters, which significantly increases the risk of rupture in the nearby hollow organs and cavities (pleural, peritoneal, pericardial).Rupture of aortic aneurysm in the projection of the pulmonary trunk promotes the development of aorto-pulmonary shunts, which entail considerable disturbances of cardiac hemodynamics.
aortic sinus aneurysms create conditions for the development of aortic valve and associated intraluminal narrowing of one or more coronary arteries.Clinical manifestations of aneurysms of this localization in the form of increased liver size, swelling of the neck veins and generalized edema syndrome caused by compression of the aneurysm influence on pulmonary trunk and the right heart.In a situation where a patient has an aneurysm of the aortic sinus giant size, compression effects on the pulmonary trunk can be fatal.
When aneurysm of the ascending aorta of the patient concerned prolonged chest pain blunt nature with severe respiratory illness in the form of progressive dyspnea.An aneurysm of the ascending aorta large size inevitably provokes the development of atrophic changes in the anterior segment of the bone ribs and sternum and the emergence of pathological pulsation right parasternal line at the second intercostal space.The appearance of a patient suffering from an aneurysm of the ascending aorta, jugular vein and swelling of limbs indicates compression impact to the superior vena cava.
aneurysm localized in the projection of the aortic arch, often manifested respiratory disorders of varying degrees of intensity which is caused by compression effect on the trachea and bronchi caliber.When compression of the left main bronchus developed segmental or lobar atelectasis.The appearance of the patient's complaints of hoarseness, persistent cough without expectoration, asthma should be regarded as compression aneurysmal sac nizhnegortannogo nerve.At the break of aneurysms of the aortic arch into the esophagus develops the classic symptoms of esophageal bleeding, need immediate medical intervention.
When aortic aneurysm localized downstream of its large size department, the patient has symptoms of neurological, simulating other diseases and complicating timely diagnosis of aneurysm.With this disease, patients pay attention to severe pain in the projection of the spine and a violation of all kinds of sensitivity.When compressive force aneurysm on the pulmonary parenchyma of the conditions for the development of pneumonia gipoventilyatsionnoy prone to the formation of lung atelectasis.Compression of the esophagus lumen manifests promote food bolus obstruction (dysphagia).Long diligence aneurysmal sac to the wall of the esophagus may form a perforation of the esophagus, which is accompanied by the development submassive esophageal bleeding.
aneurysm of the thoracic aorta, as well as thoracoabdominal has often inflammatory genesis in the syphilitic lesions.A typical manifestation of aneurysms of this localization is expressed by the appearance of pain in the epigastric projection due to a violation of the blood supply to the abdominal organs resulting from compression of the lumen of the superior mesenteric artery.
complications in aortic aneurysm can be observed in the absence of remedial measures, and in the postoperative period.When available patient aneurysm of the ascending aorta with long-term it is formed during a cardiac malformation of the aortic valve insufficiency, as well as develop signs of heart failure caused by blood circulation disorders of the coronary arteries.The most common complication is aneurysm rupture and develop its massive bleeding.The amount of blood loss during aortic rupture is very large, so this disease is characterized by the development of fulminant hemorrhagic shock.
dissecting aortic aneurysm
stratifying type of aortic aneurysm of the thoracic formed, as a rule, against a background of atherosclerotic lesions of the aortic vessel is combined with the traumatic impact on the chest of hypertension high blood pressure numbers.The initial signs of the bundle is detached intima of the aorta with subsequent development of intramural hematoma.Thus, the pathologic substrate of dissecting aortic aneurysm is an intramural hematoma, aortic wall separates into layers (inner and outer).In a situation where the bundle of the aortic wall occurs throughout the formed effect "in the lumen of the vessel."
There are three basic variants of pathogenic bundle aneurysm.In acute aortic aneurysm bundle the highest probability of death in the first 4 hours.The duration of separation in the subacute aneurysm is from five days to one month.Chronic dissecting aneurysm is extremely rare and is characterized by a slowly progressive development of damaging the wall of the aneurysm.
In acute dissecting aortic aneurysm within a patient develops clinical symptoms bright as the sudden appearance of intense pain in the substernal area, radiating to the interscapular region and upper body.There is a pathognomonic symptom is pain in the projection of moving the lumbar, epigastric and umbilical region, indicates the growing stratification and increase intramural hematoma.Character predominantly paroxysmal chest pain, which distinguishes aneurysm of an angina attack.
An objective examination of the patient can not detect pathological pulsation, auscultation a rough systolic murmur at the aorta with maximum listening auscultation in projection aneurysmal expansion.An indirect sign of aortic aneurysm is a bundle of sharp increase in the numbers of blood pressure, alternating with a sharp decrease in its performance.In order to verify the diagnosis, the patient must urgently carry out a survey radiography of the chest cavity, and if necessary - angiography.
Prior to establishing the exact diagnosis of the patient is necessary to provide emergency medical care is to conduct adequate antishock, analgesic activities.Analgesics and anti-shock activities involve the use of 0.005% solution of fentanyl in a dose of 1 ml of 0.25% together with droperidol solution at 2 mL intravenously.Prehospital when dissecting aneurysm in the absence neyroleptanalgeticheskih funds must be administered to the patient intravenously 1% morphine solution at a dose of 1 ml of a 1% solution of diphenhydramine dose of 2 ml.Intramuscular injection of a 0.1% solution of propranolol at a dose of 1 ml advisable only when having increased numbers of blood pressure in the complete absence of bronchospastic syndrome symptoms.After providing primary medical care to patients with dissecting aortic aneurysm should be hospitalized in a hospital cardiac surgery profile.
abdominal aortic aneurysm
among cardiac surgeons are of the opinion that the development of aneurysms, localized in the abdominal aorta, the most important is genetic predisposition.Furthermore, abdominal aortic aneurysm can reach critically large size exceeding 80 mm outside, which greatly increases the risk of not bundle, and rupture of the vessel wall.This localization of the aneurysm has the highest indicator of the development of complications such as rupture of the vessel wall, and the death rate is 60%.
As with other sites aortic aneurysm, aneurysmal enlargement of the abdominal often develops in the projection area of atherosclerotic lesions of the vascular wall.Second place in the structure of etiological factors causing the development of aneurysms, took a traumatic effect on the abdominal cavity and the bone-traumatic spinal injury.Syphilitic aneurysms of this localization are extremely rare and are more the exception to the rule.
The earliest sign of an aneurysm localized in the abdominal aorta, the patient is feeling abnormal pulsation in the abdomen.For aortic aneurysms of this localization is not characterized by the development of a typical pain, but some patients may note a feeling of discomfort in the back, decreasing the motion of the body.
appearance of the patient expressed pain of herpes character in the upper abdomen and the back is the earliest clinical criteria of rupture of the aneurysm.This pathology is characterized by a lightning increase of manifestations of shock due to massive bleeding into the abdominal cavity.In the absence of timely surgery, aneurysm of the abdominal aorta in the short term provokes death.
diagnosis of aortic aneurysm
Typical clinical signs of aortic aneurysm of any location appearing only in the stage of compression effects on the surrounding internal organs, so based only on the clinical picture at diagnosis is not possible.Very often the verification aortic aneurysm occurs when a routine examination of the patient using routine screening instrumental techniques.When large amounts of aneurysmal expansion and typical localization of the aneurysm experienced cardiologist can detect abnormal objective symptoms at the time of the initial examination of the patient, but the final verification of the diagnosis is possible only after the use of specific instrumental techniques of visualization.
Even when performing a routine X-ray examination in the majority of cases it is possible to correctly interpret skialogicheskuyu picture of the aneurysm, which is visualized in the form of a significant expansion of the aorta, the biasing structure of the upper floors of the mediastinum to the opposite side.In order to clarify the localization of the aneurysm patient it is advisable to perform X-rays of the chest cavity with oral contrast esophagus.Long for aortic aneurysm certainly provokes the deposition of calcium salts on its walls, which can be visualized on X-ray examination at polypositional.In a situation where the aneurysm is localized in the abdominal aorta is the major parameters in the abdominal X-ray survey can be visualized uzuratsiyu lumbar vertebrae, as well as the very aneurysmal expansion in severe calcification of the aorta wall.
Ultrasound refers to the most common method of visualization of the aneurysm, especially the abdominal aorta.Sonographic signs of aneurysm is a significant expansion of the lumen of the aorta over the vessel, as well as atherosclerotic lesion of the vascular wall.
To assess the state of the walls of the aneurysmal sac and the available evidence of aneurysm patient stratification is recommended to perform a CT scan.However, the most significant in relation to the diagnosis of aortic aneurysm angiography study is that the most accurate method to determine the localization of the aneurysmal sac, its length, and the indications for surgery.
Treatment of aortic aneurysms
Not all situations, verification of diagnosis "aortic aneurysm" is the basis for the use of surgery, however, there is a fairly narrow range of criteria that are indisputable argument in deciding on surgery.For example, the critical parameters of aneurysmal expansion of more than 5 cm, are an absolute criterion for operative resection of the aorta.In addition, the surgical removal of an aneurysm to be various sites, with all the signs of a possible rupture of the aorta and increased risk of thromboembolic complications character.Also indisputable indication for surgery is a rapidly progressive increase in the aneurysmal sac exceeding 5 mm in six months.
Note that the size of the border aortic aneurysm can occur with severe hemodynamic compromise requiring correction, so in the absence of remedial measures of conservative and surgical plan for this pathology is extremely unfavorable course and prognosis for the patient.Sudden death is usually a consequence of massive bleeding and hemorrhagic shock, which occurs when breaking the wall of the aortic vessel, but we should not forget about the risks of death due to the development of decompensated heart failure, which has a long duration and is threatening tostate of the patient's life.