THORACIC DISEASES: ANEURYSM

What is an aneurysm?

Thoracic Aortic Aneurysms are a dilation or growth of the aorta due to a weakening in the wall of the artery.  The aorta carries the entire blood flow out of the heart and supplies blood and oxygen to the brain, chest and abdominal organs. As the aorta gets larger, there is a risk that the wall of the aorta can tear or burst.

As the aneurysm grows there can be symptoms of shortness of breath, especially if the associated valve is leaking. However, in most cases thoracic aortic aneurysms tend not to cause symptoms until it is too late.  Thus, when diagnosed they should be followed by a specialized team.  Relatives of patients with thoracic aortic aneurysms should undergo an elective screening test such as echocardiography, CT or MRI.

Aneurysms can occur in one or more of the various portions of the thoracic aorta:

Aortic Root Aneurysm – portion of the aorta closest to the heart and involves the arteries that supply blood and oxygen to the heart.

Aortic Root Aneurysm

Angiographic picture of large aortic root with a severely leaking aortic valve. Note the contrast dye that is “leaking” back into the heart.

 

    Treatment for Aortic Root Aneurysm –

     Composite Root Replacement 

     Valve Sparing Root Replacement

 

Ascending Aortic Aneurysm – curved part of the aorta in the front of the chest above the coronary arteries and before the arch.

asc and hemi arch 1

 

Treatment for Ascending Aortic Aneurysm –

Ascending/hemi-arch replacement

Intraoperative photograph of a large ascending aortic aneurysm.

 

Aortic  Arch Aneurysm – part of the aorta that supplies blood to the head and neck.

 

CT images of arch aneurysms. Note the close proximity of head vessels to the dilated aortic aneurysm:

ArchAneurysm1

      Treatment  for Aortic Arch Aneurysm –

      Total Arch

      Hybrid arch

 

 

 

 

Descending Thoracic Aortic Aneurysm – straight part of aorta in the back of the chest carrying blood to the lungs, spinal cord and abdomen.  This is the portion from the Aortic Arch to the Diaphragm, the muscle that separates the chest from the abdomen.

Below CT images of a descending thoracic aorta, left before treatment and on the right following procedure.

 

Treatment for Descending Thoracic Aortic Aneurysm –

TEVAR

Descending thoracic aorta replacement