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Ascending Aortic Aneurysm Repair(Ascending)

Aneurysms in the ascending aorta and aortic arch are usually operated on immediately.

Ascending aortic aneurysms are the second most common aneurysms to an abdominal aneurysms, The most ascending aortic aneurysms are diagnosed in patients in their sixth and seventh decade of life, however patients with connective tissue disorders or those patients with a bicuspid aortic valve, are usually diagnosed earlier in life, because the patient will have a murmur that will initiate a work-up. Patients diagnosed with Marian's disease, Euler's-Danlos Syndrome, Loey-Dietz Syndrome or Familial Thoracic Aneurysm Syndrome will be screened and diagnosed early years of youth, in the adolescent years of their youth would be monitored carefully to see if there is any change in the aortic diameter. Inflammation of the arteries which is a disease of the medium of the large arteries, which can affect the ascending and aortic arch and could lead to the formation of an aortic aneurysm. Most patients usually have a past history to temporal arteritis before making a diagnosis of the problem

Causes & Symptoms

The most common causes of ascending aortic aneurysms

  • High Blood pressure
  • Smoking

Most of the patients with ascending aortic aneurysms do not really have any kind of symptoms, the most common symptoms of an ascending aortic aneurysm is a vague chest pain, In rare cases patients will have symptoms related to compression of other structures in the chest like a trachea or oesophagus, other patients will have another type of symptoms like shortness of breath or fatigue which can be secondary to aortic valve regurgitation, in the case the aortic valve would stretch as the aneurysm grows leading to incompetence and leakage of the valve.

Testing for ascending and aortic arch aneurysms

Most of the ascending aortic aneurysms are discovered by a chest x-ray or imagining studies of the chest,usually this is done to detect other medical problems. An electrocardiogram and an ultrasound will provide a clue at to that of an ascending aneurysm is present. Once the aneurysm is detected by, either a chest x-ray or an echo cardiogram, the physician further more does an MRA of CTA (scan) angiogram which shows a cross sectional view of the chest.

Treatment

Strategy

Aortic aneurysm repair
  • Surgery, by removing a portion of the aorta which contains the aneurysm replacing the the aortic aneurysm with a mesh graft
  • Re-construction after the aortic valve is affected, or either replaced or repaired

Stenting

  • The physician will make a small incision on the upper thigh into the aorta, re-insertion stent graft- polyester covered by a tubular metal web.
  • With the help of the x-ray the physician is able to get the stent-graft through the aorta to the aneurysm site
  • Once the stent graft is in place the blood flows through the stent-graft, instead of into the aneurysm, eliminating the chance to rupture.

Cardiothoracic surgeons do routinely perform:

  • Minimally invasive aortic aneurysm repairs
  • Aortic root reconstructions that preserve the aortic valve
  • Complex valve repair techniques