The Aortic Center
Definitions of Aortic Disease
- Aortic Valve Stenosis – the valve does not open well making the heart work harder
- Aortic Valve Insufficiency or Regurgitation – the valve leaks making the heart work harder
- Aortic Root Aneurysm – enlargement of the first portion of the aorta involving the area next to the heart which may affect aortic valve function.
- Ascending Aortic Aneurysm – enlargement of the aorta in the front of the chest
- Aortic Arch Aneurysm – enlargement of the aorta where the blood vessels to your head and arms start
- Descending Thoracic Aortic Aneurysm– enlargement of the aorta in your chest along the back wall
- Thoracoabdominal Aortic Aneurysm – enlargement of the aorta from the chest into abdomen often involving blood vessels to the intestines and kidneys
- Abdominal Aortic Aneurysm - enlargement of the aorta that may involve the branches that go to the legs
- Type A Aortic Dissection – tear in the wall of the aorta that starts near the heart. The blood travels between the layers of the wall of the aorta.
- Type B Aortic Dissection – tear in the wall of the aorta that starts after the blood vessels to the head. It does not involve the aorta in the front.
Causes of Aortic Disease
Aortic aneurysms form because of breakdown in the strength of the aortic wall causing a ballooning of the aorta. While the causes are not well understood, hypertension (high blood pressure), smoking, atherosclerotic disease, and family history play a role in aortic disease. This may result in aortic aneurysms, aortic dissection, or rupture of the aorta and may occur in multiple members of the family.
Genetic diseases such as Bicuspid Aortic Valve syndrome, Marfan’s Syndrome, Ehlers-Danlos Syndrome, Loeys-Dietz and Turner’s Syndromes may lead to progressive dilation of the aorta due to abnormalities in the building blocks of the aortic wall. Many genes have been identified that are associated with aortic disease. Evaluation of immediate family members of patients with aortic disease is important.
Atherosclerotic disease may produce calcification in the wall of the aorta causing plaques, ulcers, and aneurysm formation. Hypertension, or High blood pressure, strains the aortic walls and likely contributes to aneurysm growth.
Aortic dissections are a tear in the inside layer of the aorta. Blood travels inside the wall and may disrupt blood flow to vital organs, arms or legs. This can cause injury to any of the branches of the aorta and result in significant problems. Dissections of the ascending aorta should be repaired immediately due to risk of more severe disruptions in blood flow, or rupture. Those involving the descending aorta may be treated with management of hypertension (high blood pressure), but sometimes they need to be treated with surgery if problems arise. Lifelong surveillance of the aorta is necessary to deal with abnormalities of blood flow or aneurysm formation in a previously dissected aorta.
Aortic Transections or Disruption of the aortic wall may occur as a result of a motor vehicle crash, motorcycle crash, a significant fall, or other Trauma. Many of these injuries need to be treated emergently, while some can be managed without emergent surgery. Aneurysms may form in areas of aortic injury over time. Future operations are sometimes necessary with this and other aortic conditions.
Indications for Surgery
SYMPTOMS IN THE PRESENCE OF AORTIC DISEASE REQUIRES IMMEDIATE ATTENTION. Any symptomatic aortic disease may require surgery. For aneurysms, treatment (surgical or endovascular) is recommended after the diameter is 5 cm (about 2 inches) in many cases, and 5.5 cm in the majority of cases to avoid dissection or rupture. The normal size of the average aorta is about 2-3 cm (approximately 1 inch). The decision to operate is based on the cause of the aneurysm, the patient’s family history, medical conditions, and age.
Surgery on the aorta may involve the aortic valve, coronary arteries, the aorta and any of its branches in the chest or abdomen. Endovascular stent grafts will be used to repair the aorta minimally invasively whenever possible. Many times a combination of procedures is necessary to achieve the best long-term survival. Future operations on the aortic after a successful repair does occur making continued surveillance very important.
Aortic Registry for Surveillance
The goal of the Maimonides Aortic Center Registry surveillance program is to identify aortic disease early such that low-risk elective aortic aneurysm repair can be performed. We hope to decrease the occurrence of aortic dissection and rupture through outreach, education and continued surveillance of patients with aortic disease and their families. We advocate lifelong surveillance of patients with aortic disease to avoid emergent need for operations, or sudden death. It is critical that all patients with aortic aneurysms be followed on a regular basis and that all first degree relatives (parents, siblings, and children) be evaluated for aortic disease.