Aortic Aneurysmal Disease

The Aortic Institute At Yale-New Haven Milestones Achieved

Discover some of the key aneurysm “firsts” achieved here at Yale Cardiac Surgery regarding aneurysm disease. 

The aorta is the largest artery in your body and serves as the major thoroughfare through which your heart pumps blood to the rest of your body. Roughly the diameter of a garden hose in an average-sized adult, the aorta extends from the base of the heart upwards towards the head and arches downwards through your torso towards your pelvis where it divides into two major arteries to supply your lower extremities. The section of your aorta that travels in the chest is called the thoracic aorta. The section of aorta traveling in your abdomen is termed the abdominal aorta

A thoracic aortic aneurysm occurs when any portion of the aorta within the chest cavity enlarges, much like an inflating balloon. The primary risks of an enlarging aortic aneurysm are tearing of the aortic wall, referred to as dissection, and bursting or rupture. Aortic dissections or rupture are often fatal events. The risk of dissection or rupture increases with the size of the aneurysm. 

Symptoms directly related to a thoracic aortic aneurysm generally do not occur until the aneurysm is of a significant size and are often related to its location. Typical symptoms include:

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  • Pain in the center or upper chest region is often associated with aneurysms located in the upper portion of the thoracic aorta, also referred to as the ascending thoracic aorta. A rupture or tear in this region usually requires emergency surgery. 
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  • Pain in the back is often associated with aneurysms located in the lower portion of the thoracic aorta, also referred to as the descending thoracic aorta. A rupture or tear in this region can often lead to lower extremity numbness or paralysis as well as damage to your abdominal organs. A rupture or tear in this region can sometimes be treated with a stent or catheter-based procedure, but may also require urgent surgery.
  • Unexplained hoarseness or coughing
  • Shortness of breath
  • Difficulty swallowing
  • Pulsing sensation within the chest
If you experience symptoms, you should inform your physician, so that its cause can be investigated.


Causes of Aortic Aneurysmal Disease

An aortic aneurysm occurs when the walls of the aorta become weak and begin to bulge. This can be caused by several factors, including high blood pressure and atherosclerosis, a hardening of the arteries. Most aneurysms are inherited and run strongly in families. We have an advanced program for screening patients and family members for inherited causes of aneurysm disease.


Risk Factors

It is important to be aware of anything that increases your risk of developing an aneurysm. Having a risk factor does not mean that you will develop an aneurysm. Our surgeons will take the time to discuss your risk factors in detail and recommend any tests, treatments, or monitoring of the heart that may be necessary.

Risks of developing an aortic aneurysm include:
  • A family history of aneurysm disease or premature sudden cardiac death (often at an early age).
  • Very long limbs or a “double-jointed” ability.
  • (For descending aortic aneurysms and abdominal aortic aneurysms): High blood pressure, smoking, arteriosclerosis, and male gender.

Symptoms

An aortic aneurysm is a serious condition that may not present with any symptoms. They are usually found during other medical exams. Only one out of twenty patients with a thoracic aortic aneurysm has any symptoms at all. Very often, the first symptom is death or a complication that threatens the patient’s life. Those few patients who are fortunate enough to have symptoms often feel pain or discomfort in their belly, chest, or back. If you think you may have an aortic aneurysm, please contact your doctor immediately.


Diagnostic Tests

If our cardiac surgeons feel that you are at increased risk for an aneurysm, they may suggest one of several tests to check for the condition.

Chest X-ray: An image from a chest X-ray is often the most common way an aneurysm is found. We can often see the general contours of your thoracic aorta on a chest X-ray.

Echocardiogram (ECHO): An echocardiogram allows our cardiac surgeons to see the very first part of the aorta, where it exits the heart. The ECHO is a benign, comfortable, and useful imaging test—with no danger whatsoever. (Remember that newborn babies have usually had many ECHO exams in utero before birth.) The ECHO cannot see above the very start of your aorta, and there are two or three feet more of the aorta to be imaged. The ECHO also provides very valuable overall information about your heart, including size, strength, and valve function.

Computerized Tomography Scan (CT Scan): This is an imaging test that allows our cardiac surgeons to get a clear image of the aorta to look for an aneurysm. This test can show us the whole aorta from the heart, around the top of the chest, and down the back to the bottom of the belly.

Magnetic Resonance Angiography (MRA): This imaging test is similar to the CT Scan. Patients are asked to lie down on a movable table that slides into a tunnel-like machine. The magnet inside creates an image so our cardiac surgeons can determine if there is an aortic aneurysm.


Treatment

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Our internationally renowned cardiac surgeons are pioneers in the latest surgical procedures for cardiac conditions, including aortic aneurysms. Surgical treatments for aortic aneurysms include:

Open chest surgery: During this procedure, our surgeons will repair the aortic aneurysm by removing the damaged and weakened section. They will then proceed to replace that area with a synthetic tube, called a graft. This type of surgery has been done for over five decades. Our surgeons are among the most experienced in the world for these operations. We lead the way in cooling the body to permit safe surgery in the most critical and challenging part of the aorta: the so-called aortic arch.

Endovascular surgery: An endovascular procedure means that our cardiac surgeons will reinforce the weak area of the aorta with a woven tube and mesh support in order to keep it from worsening or rupturing. This is done by way of a soft, thin tube called a catheter that carries the graft into the heart through an artery in the leg.

Emergency surgery: When an aortic aneurysm ruptures, emergency surgery is required to repair the artery.

We understand that the thought of undergoing heart surgery can feel overwhelming. Our surgeons will review your surgical plan, in detail, so that you know what to expect before, during, and after your procedure. You can rest assured that you will be cared for by top surgeons internationally renowned for their minimally invasive techniques and innovative treatment strategies.