Sealing of the walls of the aorta and valves

Among the pathologies of the vascular system and circulatory system, compaction of the aorta - the main arterial vessel - is one of the first places in both prevalence and severity of consequences.

What does the compaction of the aorta mean? This is not a disease and not a symptom of the disease, but a pathological change that occurred in the structure of the wall of a given vessel and can be detected with the help of visualizing medical equipment.

Due to such changes, the aortic wall becomes less elastic, and this can negatively affect the haemodynamic function of the aorta, which ensures continuity of oxygen-containing blood flow through other arterial vessels.

[1], [2], [3], [4],

Causes of the aortic aorta

The key causes of compaction of the aorta (its walls) are associated with impaired metabolism of lipoproteins -  dyslipidemia  and its consequence - the deposition of LDL (low-density lipoprotein) on the inner surface of the vessels in the form of cholesterol plaques, that is, atherosclerosis.

Experts consider arterial hypertension, in the first place, isolated systolic arterial hypertension, the second most frequent reason for the decrease in the elasticity of the walls of the aorta . Gradual increase in the density of the endothelium, subendothelial and medial layer of the aorta walls with the formation of dense structures of fibrous character makes them more stringent. And this happens, it is believed, due to the constant hydromechanical pressure of blood continuously moving through the vessel at an average velocity of 50 cm / sec. And a blood pressure of at least 120 mm Hg. Art. Although it is this causal relationship between the development of hypertension and the increased stiffness of the aorta walls that has recently been questioned and may have an inverse sequence.

Also, the vascular wall may partially lose its elasticity as a result of:

• age fibrous involution of the tissues of the walls of the aorta;
• chronic aortic inflammation (aortitis), which develops with tuberculosis, syphilis and streptococcal infections;
• presence of systemic autoimmune pathologies (rheumatoid arthritis, systemic scleroderma or lupus);
• genetically conditioned collagenopathy (connective tissue dysplasia) in the form of a vascular syndrome with endothelial dysfunction.

[5], [6], [7], [8], [9], [10]

Risk factors

Among the risk factors for compaction of the aorta walls, besides hereditary predisposition and congenital aortic heart defects, angiologists and cardiologists note:

• the age factor;
• Smoking, alcohol abuse, excessive physical exertion;
• too many animal fats in the diet (contributing to an increase in the level of LDL);
• metabolic syndrome ;
• diabetes.

An important risk factor for reducing vascular elasticity is the lack of copper in the body, because of which the strength of crosslinks in the molecules of fibrillar proteins elastin and collagen (which are the main components of the tissue of the vascular walls) decreases.

[11], [12], [13], [14], [15], [16], [17], [18], [19]

Pathogenesis

The pathogenesis of increasing the density of the aorta directly depends on its cause and lies in the structural features of the wall of this vessel.

The aorta is an elastic artery with three membranes: inner, middle and outer. The inner membrane (intima) consists of interconnected large endotheliocytes. Next is a subendothelial layer of amorphous fibers of collagen and elastin, and above it is the elastin membrane separating the intima from the middle membrane.

Medium cladding tissue is an extracellular matrix with the inclusion of collagen, myocytes (smooth muscle cells), glycosaminoglycans, fibroblast cells, structural fibronectin protein, and various immune cells. But the outer shell of the aorta is formed by the fibers of elastin and collagen.

It is this structure of the walls of the aorta that ensures its elasticity, strength and biomechanical properties that determine the hemodynamic functions of this blood vessel. During systole (contraction of the left ventricle of the heart), the walls of the aorta are able to assume the release of blood, while the vessel expands, and the stretching of the wall gives potential energy that allows maintaining blood pressure during the diastolic phase of the cardiac cycle, since during this time the aorta passively contracts . And the elastic recoil of its walls helps to save the energy of contractions of the myocardium and to smooth the heart pulse created by the heart.

Elevated blood pressure (arterial hypertension) causes a constant stress of the walls of the aorta and, over time, the loss of their elasticity.

Sclerotic densification of the walls of the aorta in atherosclerosis occurs due to the accumulation in the middle layer of its wall of lipids, which, in the form of cholesterol conglomerates or  cholesterol plaques,  are introduced directly into the intercellular matrix and gradually expand inside the vessel, thickening its wall and decreasing the lumen.

Also, the elastic layer of the aortic wall is prone to involutional changes, the pathogenesis of which is due to the fact that with age its structural homogeneity is disrupted due to focal fibrosis or calcification.

The age-related increase in the level of fibronectin produced by the endothelial cells of the aorta leads not only to the adhesion of platelets and the formation of agglutination thrombi, but also activates the synthesis of growth factors (PDGF, bFGF, TGF) by endothelium. As a result, the proliferation of fibroblasts and myocytes intensifies, and the aortic wall thickens and becomes denser.

As experts note, the level of fibronectin can increase at any age in the metabolic syndrome.

[20], [21], [22], [23], [24], [25], [26]

Symptoms of the aortic aorta

Reduction of the elasticity of the aorta wall at the early stage of the pathological process does not show itself. Moreover, aorta compaction on fluorography is often detected spontaneously - in the total absence of any complaints from patients.

In addition, the symptoms of aortic compaction are nonspecific. For example, moderate compaction of the aorta in the area of its arch can be accompanied by frequent headaches, dizziness, increased fatigue.

When the root of the aorta and its ascending part become denser, there is a feeling of discomfort in the mediastinum, an increase in heart rate, pain behind the breastbone during physical exertion. Attacks similar to angina pectoris may occur if the aortic valve seal is combined with left ventricular hypertrophy.

When compaction of the abdominal aorta, patients can complain of weight loss, digestive problems, abdominal pain of the pulling nature, cramps in the muscles of the lower limbs, leg pain while walking and unilateral limp.

Forms

The aorta, the main artery of the great circle of the circulation, comes from the left ventricle of the heart, extending to the abdominal cavity, where it divides into two smaller (iliac) arteries. Forms or types of compaction of the aorta specialists determine by its location.

If the increase in vascular wall density is found at the beginning of the aorta - in the area of its dilated (bulbar) part, it is defined as a compaction of the root of the aorta.

In the same part, next to the mouth of the vessel, is the ascending aorta (not more than 5-6 cm long) originating in the thorax on the left - near the lower edge of the third intercostal space, rising to the second rib on the right thorax. With this localization, the consolidation of the ascending aorta is ascertained.

In addition, since the ascending aorta extends from the cardiac aortic valve regulating the flow of blood into the aorta from the left ventricle (and preventing back-flow of blood), the aortic valve seal can be fixed.

With the compaction of the valves (elastic locking structures) of the aortic valve, aortic insufficiency is associated . Anatomic and functional connection can manifest itself in such a simultaneous vascular pathology as compaction of the walls and aortic valves.

Densification of the aorta and valves of the aortic and mitral valve can also be detected. If the aortic valve of the heart separates the aorta from the left ventricle, the mitral separates the left atrium from it and does not cause blood flow in the opposite direction during the systolic contraction (that is, it interferes with regurgitation).

Sealing the aortic arch means localizing the pathology in an area where the ascending part of this vessel at the level of the second rib makes a leftward and upward turn (above the left pulmonary artery and the left bronchus). Three large arteries branch off from the arc: the brachiocephalic trunk, the left common carotid and left subclavian artery.

Abdominal (abdominal) aorta is part of the descending aorta; is located below the diaphragm. And compaction of the abdominal aorta can disrupt normal blood flow along the arteries that leave it - the iliac and mesenteric.

When the compaction of the aorta and left ventricle is established (in the sense of its walls), it means that prolonged high blood pressure in the patient led to  hypertrophy of the left ventricle  (an increase in the thickness of its wall) with simultaneous lesion of the aortic wall of any etiology. Given all the negative consequences of this combination for hemodynamics, cardiologists note its danger: the frequency of mortality is 35-38 cases per thousand.

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Complications and consequences

Is it dangerous and what causes the compaction of the aorta? Compaction of the aorta is a pathological condition of the vascular system, which has certain consequences and complications, including life-threatening ones.

The defeat of the aorta by cholesterol plaques, on the one hand, narrows the lumen of the vessel and reduces the elasticity of its walls, and on the other, causes compaction and aortic expansion - an aneurysm. In this case, the constantly high blood pressure on the walls of the aorta can lead to their stratification, which is fraught with perforation of the vascular wall with a huge loss of blood and fatal outcome.

Read also -  Aneurysm of the aorta of the abdominal cavity

Sealing of the aorta and valves of the aortic valve leads to its insufficiency with diastolic regurgitation of part of the blood into the ventricle, which increases its volume and increases the pressure during diastole. As a result, hypertrophy of the left ventricle of the heart develops, which can progress and cause a violation of its contractile functions.

The consequence of severe cases with the consolidation of a significant part of the aorta is the violation of coronary blood flow and myocardial ischemia, sometimes irreversible.

[29], [30], [31], [32], [33]

Diagnostics of the aortic aorta

For the purpose of revealing the pathology of the walls of the aorta - if a patient does not have atherosclerosis or metabolic syndrome - blood tests for sugar and cholesterol should be submitted.

Doctors can detect aortic compaction on fluorography (chest X-ray); The compaction of the aorta with ultrasound of the heart is clearly visualized.

In addition, instrumental diagnostics uses:

• electrocardiography (ECG);
• ultrasound echocardiography;
• angiography with contrast agent;
• MRT.

[34], [35], [36], [37]

Treatment of the aortic aorta

When the walls of the aorta are compacted, the treatment is determined by the causes of this pathology. Thus, for atherosclerosis with aortic lesions of cholesterol plaques, cholesterol plaques are used to reduce cholesterol in the blood and reduce its production in the body, for more details see -  Treatment of elevated cholesterol, and - How to lower cholesterol in blood without drugs?

With any etiology of reducing the elasticity of the walls of the aorta, vitamins C, E, B5 and PP, as well as polyunsaturated fatty acids omega-3 and omega-6 are recommended.

In the case when the specific cause of the pathology is not established, the patient - provided that there are no symptoms - is given a standard advice: adhere to a healthy lifestyle, eat right and avoid stress.

Surgical treatment is carried out:

• with the dissection of the aorta - by stenting the vessel on the damaged area or its endoprosthetics;
• when sealing the valves of the aortic and mitral valve - their plastic correction or complete replacement;
• at an aneurysm - a resection with replacement of the removed site by a prosthesis.

Folk treatment of aortic aorta

The most effective folk remedy is garlic oil. To make it, you need to clean and grind one large head of garlic and mix with 200-250 ml of corn oil.

This mixture should be stirred periodically during the day, after which the container should be tightly closed and put for a week in a cool place.

Garlic oil is used one teaspoon three times a day (for 30-40 minutes before meals). One course of this treatment lasts three months, after which it is necessary to take a break for a month.

[38], [39], [40], [41], [42], [43], [44]

Prevention

Only some diseases can be prevented, leading to an increase in the density of the walls of the aorta. For example, it is possible to  prevent arterial hypertension. However, there are no special methods for preventing aortic compaction.

[45], [46], [47], [48], [49], [50], [51]

Forecast

The prognosis regarding compaction of the walls of the aorta, as well as its treatment, is determined by the causes of this pathology ...

Fortunately, the aortic rupture with its dissection and aneurysm does not happen very often, but even timely intervention in 90% of cases does not save from a fatal outcome.

[52], [53], [54], [55]