What Is a Ventricular Septal Aneurysm?

Congenital aneurysm is a cerebrovascular disease that often causes subarachnoid hemorrhage, and is not a true intracranial tumor. Congenital aneurysms occur predominantly in the arteries or their branches that make up the cerebral basilar artery ring. The incidence of internal carotid artery was significantly higher than that of vertebral artery. It is more common near the junction of the internal carotid artery and the posterior communicating artery. Often single, can be multiple, and even combined with other types of cerebrovascular malformations. Congenital aneurysms often show symptoms later in adulthood.

Congenital aneurysm

Introduction

Congenital aneurysm is a cerebrovascular disease, which is mainly caused by a weak congenital artery wall. Mostly cystic, accounting for 80% to 90% of the total. It often causes subarachnoid hemorrhage and is not a true intracranial tumor. Congenital aneurysms occur predominantly in the arteries or their branches that make up the cerebral basilar artery ring. The incidence of internal carotid artery was significantly higher than that of vertebral artery. It is more common near the junction of the internal carotid artery and the posterior communicating artery. Often single, can be multiple, and even combined with other types of cerebrovascular malformations. Congenital aneurysms often show symptoms later in adulthood.

Congenital aneurysms are generally small in size, with diameters usually between 0.4 and 1.0 cm, and there are also smaller than 0.4 cm, which is miliary aneurysms. The volume can reach 5 cm in diameter, and the literature has reported a huge aneurysm with a diameter of 8.5 × 5.5 × 5 cm.

Congenital aneurysms are unevenly thick and generally thin. The muscle layer and intimal elastic layer of the normal arterial wall often stop at the neck of the aneurysm, so most of the tumor wall is only some fibrous tissue from the intima or adventitia. The small bleeding spots and pigments that are scattered in the wall are common Phagocytic cells can also have infiltrates of chronic inflammatory cells. Therefore, under the condition that the tumor wall is gradually expanding, the tumor wall is necrotic, resulting in fissures or rupture, and bleeding or bleeding is completely possible. On the other hand, due to the poor circulation of blood in the tumor cavity and the rough wall of the tumor, complete or partial fine thrombus formation is also possible. Therefore, the tumor cavity is not necessarily full of blood. The size and shape of the tumor cavity Nor does it necessarily represent the size and shape of the tumor.

Causes of congenital aneurysms

Cerebral aneurysms are structurally poorly developed arterial walls in the brain, or are caused by brain trauma, arteriosclerosis, or aging, causing the local vessel wall to swell outward, and the arterial wall of congenital aneurysms Most of them have focal congenital developmental defects, such as weak or disappearing muscle layer or elastic layer. Under the long-term impact of arterial pressure, they gradually expand and become aneurysms, often cystic or berry-like. Occasionally becomes a dissecting aneurysm. It is also believed that congenital aneurysms are formed based on the remnants of certain embryonic blood vessels.

The manifestation of congenital aneurysm rupture depends on the size and location of the tumor. Most of the onsets are sudden and sudden headache, vomiting, disturbance of consciousness or coma occur suddenly. Congenital aneurysm rupture is often caused by emotional excitement, fatigue, alcohol consumption, and late pregnancy. A few patients can start slowly without subarachnoid hemorrhage or cerebral parenchymal hematoma, and the condition can be less dangerous.

Congenital aneurysm symptoms

Onset symptoms are sudden onset with severe headaches, nausea, and vomiting. Congenital aneurysm is a cerebrovascular disease that often causes subarachnoid hemorrhage, and is not a true intracranial tumor.

Congenital aneurysms occur predominantly in the arteries or their branches that make up the cerebral basilar artery ring. The incidence of internal carotid artery was significantly higher than that of vertebral artery. It is more common near the junction of the internal carotid artery and the posterior communicating artery. Often single, can be multiple, and even combined with other types of cerebrovascular malformations. Congenital aneurysms often show symptoms later in adulthood.

After the rupture of a congenital aneurysm, due to the effects of serotonin and blood vessel distortion, compression, laceration, etc., proximal or distal arterial spasm often occurs, and even thrombosis occurs. Dissecting aneurysms can cause luminal obstruction or thrombosis and cause cerebral infarction. Therefore, when an aneurysm ruptures, due to hematoma, cerebral edema, increased intracranial pressure, or clot emboli, etc., cerebral embolism in other parts may occur, and gross or microscopic brain softening may occur. However, it is often accompanied by ischemic lesions.

The following is the content of the aortic valve sinus aneurysm.

Congenital aneurysm diagnosis

For the diagnosis of aortic valve sinus aneurysms, it is generally not difficult to determine based on medical history, physical examination, and cardiac continuous murmur, combined with X-rays and echocardiography. For some diagnostic skeptics, a right heart and right catheter examination or retrograde aortic angiography is required when a differential diagnosis is needed.

Congenital aneurysm treatment

Aortic valve sinus aneurysm gradually develops and expands after the formation, which will eventually lead to aneurysm rupture. Therefore, those diagnosed with aortic valve sinus aneurysms should undergo aortic valve sinus aneurysm resection regardless of rupture or not. For patients with acute rupture, surgical treatment should be performed as soon as possible after the improvement of heart failure by medical treatment. If heart failure is not controlled, surgery should be performed early. The operation was performed under direct circulation repair combined with hypothermia and myocardial protection. The patient took a supine position, the sternum was cut in the middle, the sternum was sawed longitudinally, and the tremor was felt after breaking into the heart surface. If necessary, do a heart search.

The cardiac incision route is based on the aortic valve sinus aneurysm breaking into the cavity or associated with heart malformation to decide on the right atrium, right ventricle, or aortic incision. The heart was cut open to reveal the lesion. The tumor was thin and smooth with a wind-like wall. There was one or several openings on the top. The ruptured aneurysm had two internal and external openings. The internal opening was located at the aortic valve sinus and the tumor wall was cut longitudinally. The entire capsular wall is cut in a circular manner at about 0.3 to 0.4 cm from the inner mouth, and the tougher cyst wall tissue around the inner mouth is retained for suture. During the suture, a "8" continuous suture is firstly made, and then cushioned sutures are added on both sides of the capsular wall. To reinforce the stitching. Through the aortic incision, the cardioplegic solution can be perfused directly from the opening of the coronary artery, and the leaflets can be accurately inspected. The cystic sinus tumor can be retracted into the aorta from the right atrium or the right ventricle, and the excess tumor wall can be removed. The sinus tumor can be removed. And the suture method is consistent with the above. The combined supracondylar ventricular septal defect can be repaired through an aortic incision or a right ventricular incision. If it is accompanied by aortic valve insufficiency, it can be used for aortic valve angioplasty or aortic valve replacement.

(1) Rupture of right coronary sinus tumor into right ventricle

(2) Aortic root or right ventricle incision

(3) Aortic suture after the capsule is removed

(4) suture breach through right ventricle

(5) "8" suture at the mouth of the capsule, if necessary, add a woven mattress suture

Congenital aneurysm pathological changes

After aortic valve sinus aneurysm rupture, it usually ruptures into the right low-pressure ventricle, and blood flows from the high-pressure aorta into the low-pressure right ventricular cavity. Due to the obvious pressure difference between the two, a large amount of left-to-right shunts are generated. The hemodynamic changes are similar to those of an open arterial catheter, increased pulmonary circulation blood flow, and increased right ventricular load, leading to right ventricle enlargement, pulmonary hypertension, and right heart failure. Aortic valve sinus aneurysm breaking into the right atrium cavity will increase the pressure of the right atrium significantly, the right atrium will be significantly enlarged, the blood flow of the superior and inferior vena cava will be blocked, and symptoms of right heart failure will appear. Rupture of the aortic valve sinus aneurysm into the pericardial cavity results in acute cardiac tamponade and death.

Aortic valve sinus aneurysms can often be combined with other cardiac malformations, the most common of which is a concurrent ventricular septal defect (about 40-50%), which makes the left and right ventricle more burdensome. It is also often accompanied by aortic valve insufficiency, pulmonary artery stenosis, aortic constriction, and open ducts.

The course of the disease varies with the size of the breach. The larger the breach, the more the left-to-right partial flow, the earlier the symptoms appear and the disease progresses faster.

Clinical manifestations of congenital aneurysms

Unruptured aortic valve sinus aneurysms do not show clinical symptoms, and symptoms only appear after rupture. The age of onset is mostly between 20 and 40 years old. About 1/3 of the patients have an acute onset, and suddenly feel severe pain in the anterior heart area or upper abdomen, chest tightness and dyspnea during severe labor. The condition is similar to angina. Those whose condition deteriorates rapidly can die of right heart failure within a few days after onset. In most cases, the breach is small, and there may be weeks, months, or years of remission after the onset, and then symptoms of right heart failure appear. A small number of patients have only a small amount of left-to-right shunt due to very few breaches. For a long time, patients may have no conscious symptoms. These patients are often accidentally found due to cardiac murmur. They are detected by echocardiography, right heart catheterization and aortic angiography. And diagnosis.

Physical examination: Diastolic blood pressure decreased significantly, pulse pressure difference increased, water pulse, capillary pulsation, and femoral artery gunshot sounds appeared. During cardiac examination, tremors can be felt in the 3rd and 4th intercostal space of the left margin of the sternum. Typical rough and continuous murmurs can be heard there. The nature of the murmur is similar to that of an arterial duct, but the murmur position is lower and the aortic valve sinus Cases of aneurysm breaking into the right atrium often show jugular venous distension. Electrocardiogram: left ventricular hypertrophy or biventricular hypertrophy, myocardial damage, and right bundle branch block. X-ray chest X-ray: the heart is enlarged significantly, the pulmonary artery is prominent, and the lung field is congested and the lung texture is increased. Echocardiographic examination: showing the middle segment of the aortic sinus wall waveform, the diastolic aortic sinus wall prolapsed into the right ventricular outflow tract. Right heart catheterization examination: It can be confirmed that blood oxygen saturation is increased in the right atrium, right ventricle or pulmonary artery, suggesting that there is a left-to-right shunt in this part. Retrograde aortic angiography: can identify the site of aortic sinus tumor breach and the heart chamber that has penetrated.

Differential diagnosis of congenital aneurysms

The following diseases should be distinguished from aortic valve sinus aneurysms:

(1) Heart malformations with left to right shunts in the aorta such as open arterial ducts and aortic pulmonary artery septal defects have no history of sudden onset, machine-like continuous murmurs are located in the second left intercostal space, and the murmurs often go to both lungs and the same side Subclavian conduction and echocardiographic examination have left-to-right shunts in the descending aorta and left pulmonary arteries. If necessary, a right heart catheterization or retrograde aortic angiography can be used to confirm the diagnosis.

(2) Ventricular septal defect coexisting with aortic valve insufficiency. There is no sudden history of this disease. The systolic and diastolic reciprocating murmur sites are in the left and right intercostal spaces. Echocardiographic examination shows the absence of ventricular septal echo segments and ventricles. There is a left-to-right shunt in the lumen, and the aortic valve can show signs of valve insufficiency.

(C) Coronary fistula refers to the abnormal communication between the left and right coronary arteries and the heart cavity or coronary veins. Continuous murmurs can be heard below the precardiac area, mainly diastolic. Echocardiography or retrograde aortic angiography showed that the coronary arteries were dilated, and that the contrast agent flowed from the coronary arteries into the heart cavity.

Prognosis of congenital aneurysm

The domestic surgical mortality rate is about 5-10%, and the long-term results of the surgery are satisfactory.

Congenital aneurysm experts remind

Two experts especially reminded that maintaining an optimistic and positive attitude, developing healthy and good living habits, and learning to relieve stress can reduce the incidence of cerebral aneurysm rupture to a certain extent. If the patient develops symptoms such as sudden severe headache, jet-like vomiting, and disturbance of consciousness, the patient's respiratory tract should be kept as smooth as possible and quickly sent to the hospital for treatment. DSA (Digital Subtraction Angiography) is the "gold standard" for the diagnosis of cerebral aneurysms. Magnetic resonance examination can also detect the disease. Depending on the location of the cerebral aneurysm, you can choose interventional therapy or aneurysm neck clamping surgery. And it is found that the earlier the treatment effect is better.