Conditions | Aortic Aneurysms | Aortic Dissection | Aortic Insufficiency | Aortic Stenosis
Bicuspid Aortic Valve | Connective Tissue Disease | Endocarditis
Bicuspid Aortic Valve | Connective Tissue Disease | Endocarditis
Aortic Root Aneurysm
What is an aneurysm?An aneurysm is an abnormal dilatation of the wall of a blood vessel that is 50% greater than the artery's normal diameter (width). An aneurysm may be located in many areas of the body, such as the blood vessels of the brain, the aorta (the largest artery in the body), the intestines, the kidneys, the spleen, and the vessels in the legs.
What are the causes of aortic root aneurysms?Causes of aortic root aneuryms may include, but are not limited to, the following:
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FAQ
What is an enlarged aorta? An enlarged aorta is also known as an aortic aneurysm... What is transcatheter aortic valve implantation (TAVI)? TAVI also known as transcatheter aortic valve reimplantation (TAVR)... Can I exercise if I have an enlarged aorta, aortic aneurysm, or chronic dissection? Though some types of exercise should be avoided, exercise is generally encouraged... Who should be screened for an aortic aneurysm? Most people with aortic aneurysms experience no symptoms... |
Why does an aortic root aneurysm need to be treated?
An aneurysm may continue to increase in size, along with progressive weakening of the artery wall, surgical intervention may be needed.
The valve may become leaky (aka regurgutant) as a result of enlargement (or dilatation) of the aortic annulus. This may also result from structural defects in the valve leaflets. Conversely, the valve may become narrowed (or stenotic) resulting in the restriction blood flow.Either of these conditions may require treatment.
Preventing rupture of an aneurysm is one of the goals of therapy. The larger an aneurysm becomes, the greater the risk of rupture (bursting). With rupture, life-threatening hemorrhage (uncontrolled bleeding) may result.
The valve may become leaky (aka regurgutant) as a result of enlargement (or dilatation) of the aortic annulus. This may also result from structural defects in the valve leaflets. Conversely, the valve may become narrowed (or stenotic) resulting in the restriction blood flow.Either of these conditions may require treatment.
Preventing rupture of an aneurysm is one of the goals of therapy. The larger an aneurysm becomes, the greater the risk of rupture (bursting). With rupture, life-threatening hemorrhage (uncontrolled bleeding) may result.
What are the symptoms of an aneurysm?
Aortic disease is often insidious. Most people with aortic aneurysms experience no symptoms, unless they are extremely large or an aortic dissection occurs. For most people, their aortic condition is discovered incidentally while being tested for other reasons.
When present, symptoms may occur with different types of aneurysms may include, but are not limited to, pain in the jaw, neck, chest and/or back; wheezing, coughing or shortness of breath; hoarseness or difficulty swallowing. The symptoms of an aneurysm may resemble other medical conditions or problems, including heart attacks, pneumonia, and digestive conditions. Always consult your physician for more information.
When present, symptoms may occur with different types of aneurysms may include, but are not limited to, pain in the jaw, neck, chest and/or back; wheezing, coughing or shortness of breath; hoarseness or difficulty swallowing. The symptoms of an aneurysm may resemble other medical conditions or problems, including heart attacks, pneumonia, and digestive conditions. Always consult your physician for more information.
How are aneurysms diagnosed?For most people, their aortic condition is discovered incidentally while being tested for other reasons. For patients suspected to have aortic disease, selection of a type of diagnostic examination is related to the location of the aneurysm. In addition to a complete medical history and physical examination, diagnostic procedures for an aneurysm may include any, or a combination, of the following:
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If my aneurysm is not causing symptoms, why do I need surgery?
The objective of surgical repair of an aneurysm is to treat or prevent potential complications related to the aneurysm. These include:
In addition, the risk of aortic catastrophe, including dissection and rupture, increases dramatically after the aneurysm reaches 5 centimeters.Surgery is generally recommended when the proximal aorta is larger than 5 centimeters. However, depending on other factors, including other vascular conditions or the need for additional surgery (particularly heart surgery), this threshold varies with individual patients.
- heart attack
- aortic valve regurgitation
- heart failure
- hoarseness due to left vagus or left recurrent laryngeal nerve compression
- diaphragmatic paralysis due to phrenic nerve compression
- difficulty breathing due to airway compression
- difficulty swallowing due esophageal compression
- swelling of the head or arm due superior vena cava syndrome
- blood clots
- aortic dissection
- rupture of the aorta
In addition, the risk of aortic catastrophe, including dissection and rupture, increases dramatically after the aneurysm reaches 5 centimeters.Surgery is generally recommended when the proximal aorta is larger than 5 centimeters. However, depending on other factors, including other vascular conditions or the need for additional surgery (particularly heart surgery), this threshold varies with individual patients.
Specific treatment will be determined by your physician based on:
- age, overall health and medical history
- size and extent of the disease
- signs and symptoms
- tolerance of specific medications, procedures or therapies
- expectations for the course of the disease
- patient preference
What are surgical treatment options?
At RWJ, surgery on the proximal aorta is performed using antegrade cerebral perfusion (ACP) via axillary cannulation. Traditionally, surgery on the proximal aorta required complete circulatory arrest, which leaves the patients without blood circulation for a period of time. The method of ACP used enables surgeons to maintain the flow of blood to the brain and other part of the body throughout the operation. It has been shown to be safer than traditional approaches, specifically decreasing the risk of stroke and other neurological injury.
Surgical Options for Aortic Root Aneurysms:
Valve-sparing root replacement: When the aorta is dilated but the aortic valve is otherwise normal, the aortic can be fixed while preserving the valve. This avoids the need for a valve replacement with an prosthetic valve as well as the potential need for blood thinning medication.
Biological composite aortic graft: The aortic root and valve is replaced with a bio-prosthetic valved conduit. This has a number of potential advantages, including the avoidance of the need for blood thinning medications.
aortic root replacement with tissue valve aortic graft and coronary reimplantation
Mechanical valve conduit: Also called the "modified Bentall" operation, this approach is often used in younger patients or in those patients who wish to avoid reoperation. The entire aortic root and aortic valve is replaced with a combination of a mechanical valve within a graft conduit. However, anticoagulation therapy is required.
Homograft root replacement: The aortic root is then reconstructed using cadaveric human (homograft) aorta. This eliminates the need for blood thinning medication and may provide superior blood circulation and valvular function, thus providing a longer period of freedom from reoperation than animal tissue alternatives.
Surgical Options for Aortic Root Aneurysms:
Valve-sparing root replacement: When the aorta is dilated but the aortic valve is otherwise normal, the aortic can be fixed while preserving the valve. This avoids the need for a valve replacement with an prosthetic valve as well as the potential need for blood thinning medication.
Biological composite aortic graft: The aortic root and valve is replaced with a bio-prosthetic valved conduit. This has a number of potential advantages, including the avoidance of the need for blood thinning medications.
aortic root replacement with tissue valve aortic graft and coronary reimplantation
Mechanical valve conduit: Also called the "modified Bentall" operation, this approach is often used in younger patients or in those patients who wish to avoid reoperation. The entire aortic root and aortic valve is replaced with a combination of a mechanical valve within a graft conduit. However, anticoagulation therapy is required.
Homograft root replacement: The aortic root is then reconstructed using cadaveric human (homograft) aorta. This eliminates the need for blood thinning medication and may provide superior blood circulation and valvular function, thus providing a longer period of freedom from reoperation than animal tissue alternatives.