Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan Health Center, Ann Arbor, MI 48109, USA.
Am Heart J. 2011 Jul;162(1):38-46.e1. doi: 10.1016/j.ahj.2011.04.010. Epub 2011 Jun 15.
Thoracic aortic enlargement is an increasingly recognized condition that is often diagnosed on imaging studies performed for unrelated indications. The risk of unrecognized and untreated aortic enlargement and aneurysm includes aortic rupture and dissection which carry a high burden of morbidity and mortality. The etiologies underlying thoracic aortic enlargement are diverse and can range from degenerative or hypertension associated aortic enlargement to more rare genetic disorders. Therefore, the evaluation and management of these patients can be complex and requires knowledge of the pathophysiology associated with thoracic aortic dilation and aneurysm. Additionally, there have been important advances in the treatment available to patients with thoracic aortic disease, including an increased role of endovascular therapy. Given the risk of mortality, increased clinical recognition and advances in therapeutics, the American College of Cardiology, American Heart Association and related professional societies have recently published guidelines on the management of thoracic aortic disease. This review focuses on the pathophysiology and various etiologies that lead to thoracic aortic aneurysm along with the diagnostic modalities and management of asymptomatic patients with thoracic aortic disease.
胸主动脉扩张是一种越来越被认识到的病症，通常在为其他无关适应证进行影像学检查时被诊断出来。未被识别和未治疗的主动脉扩张和动脉瘤的风险包括主动脉破裂和夹层，这些疾病的发病率和死亡率都很高。胸主动脉扩张的病因多种多样，可包括退行性或与高血压相关的主动脉扩张，以及更罕见的遗传疾病。因此，这些患者的评估和管理可能很复杂，需要了解与胸主动脉扩张和动脉瘤相关的病理生理学。此外，胸主动脉疾病的治疗方法也取得了重要进展，包括血管内治疗的作用增加。鉴于死亡率风险、临床认知的提高和治疗方法的进步，美国心脏病学会、美国心脏协会和相关专业协会最近发布了胸主动脉疾病管理指南。这篇综述重点介绍了导致胸主动脉瘤的病理生理学和各种病因，以及无症状胸主动脉疾病患者的诊断方法和管理。
