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Tetralogy of Fallot
Thoracic Aortic Aneurysm
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Ventricular Septal Defect (VSD)


Thoracic Aortic Aneurysm

What is Thoracic Aortic Aneurysm?

Thoracic aortic aneurysm is a potentially life-threatening disorder characterized by abnormal widening of the ascending, transverse, or descending part of the aorta. The aneurysm may be saccular, an outpouching of the arterial wall. with a narrow neck, involving only a portion of the vessel circumference; or fusiform, a spindle-shaped enlargement, encompassing the entire aortic circumference.

Dissection of the aneurysm is the circumferential or transverse tear of the aortic wall intima, usually within the medial layer. It occurs in about 60% of patients, is usually an emergency, and has a poor prognosis.

The ascending thoracic aorta is the most common site for the aneurysm, which occurs predominantly in men under age 60 who have coexisting hypertension. Descending thoracic aortic aneurysms are most common in younger patients who have had chest trauma.

Causes of Thoracic Aortic Aneurysm

Commonly, ascending thoracic aortic aneurysm results from atherosclerosis, which weakens the aortic wall and gradually distends the lumen in this area. It's also closely associated with cigarette smoking and hypertension.

Descending thoracic aortic aneurysm usually occurs after blunt chest trauma that shears the aorta transversely (acceleration-deceleration injury), such as in a motor vehicle accident, or a penetrating chest injury such as a knife wound. It also may be caused by hypertension.

Mycotic aneurysm develops from staphylococcal, streptococcal. or salmonella infections, usually at an atherosclerotic plaque.

Cystic medial necrosis caused by degeneration of the collagen and elastic fibers in the media of the aorta causes aneurysms during pregnancy and in patients with hypertension and Marfan syndrome. However, it can also be the cause without any underlying condition.

Other causes include congenital disorders. such as coarctation of the aorta, syphilis infection, and rheumatic vasculitis.

Signs & Symptoms of Thoracic Aortic Aneurysm

Thoracic aortic aneurysms often go unnoticed because patients rarely feel any symptoms. While only half of those with thoracic aortic aneurysms complain of symptoms, possible warning signs include:

  • Pain in the jaw, neck, and upper back
  • Chest or back pain
  • Coughing, hoarseness, or difficulty breathing

Diagnostic Tests

In an asymptomatic patient. the diagnosis commonly occurs accidentally. through posteroanterior and oblique chest X-rays showing widening of the aorta and mediastinum.

An aortogram (a special set of x-ray images made during injection of dye into the aorta) can identify the aneurysm and any branches of the aorta that may be involved.

Treatment

For long-term treatment, beta-adrenergic blockers and other agents can control hypertension and cardiac output. In an emergency, antihypertensives such as nitroprusside, negative inotropic agents such as labetalol, oxygen for respiratory distress, narcotics for pain, l.V. fluids; and whole blood transfusions, if needed, may be used.

in dissecting ascending aortic aneurysm - an extreme emergency - surgical resection of the aneurysm can restore normal blood flow through a Dacron or Teflon graft replacement. With aortic valve insufficiency, surgery consists of replacing the aortic valve.

Postoperative measures include careful monitoring and continuous assessment in the intensive care unit, antibiotics, insertion of endotracheal and chest tubes, ECG monitoring and, in many instances, pulmonary artery catheterization and monitoring.

Prevention Tips

Prevention measures for atherosclerosis, in general, include not smoking, controlling blood pressure and blood lipid levels, and exercising routinely.



 

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