Dissecting Aneurysm

The dissecting aneurysm is caused by the disruption of the intima, which occurs mainly in the region of the ascending part of the aorta. Promotes aortic dissection of Marfan syndrome, high blood pressure, pregnancy, idiopathic kyphoscoliosis. Blood through the defect of the inner shell rushes into the wall of the aorta, destroys the middle shell and separates the inner shell from the outer one.

Complications: rupture of the aneurysm, narrowing of the aortic lumen and vessels leaving it.

Symptoms, course. The main symptom is a sharp growing pain in the chest. The pain syndrome is very pronounced, sometimes accompanied by shock, and the pain syndrome increases with the increase in blood pressure.

The diagnosis is based on data from an overview radiograph of chest organs, computer X-ray tomography and aortography. During the first day after the onset of aortic dissection, 25% of patients die, within a week-50%, a month-75%. More than a year, only 10% of patients live. The cause of death is the rupture of the exfoliating aneurysm and bleeding into the pericardial cavity, mediastinum, pleural cavity.

Treatment. Emergency measures consist in lowering blood pressure to 100-120 mm Hg. Art. , A decrease in the rate of ventricular ejection with beta-blockers. These measures reduce the spread of aneurysmic dissection. Surgery for prosthetic repair of the aortic segment is indicated in cases of severe aortic valve failure that has arisen on the soil of the exfoliating aneurysm, with increasing delaminating hematoma and the risk of rupture, with a significant narrowing of the main branches of the aorta, with proven blood flow to the pericardium and pleura, unsuccessful conservative therapy And noncorrectable arterial hypertension. The lethality with such interventions is 10-20%, the five-year experience is about 50%.