thoracic aortic aneurysmDefinition
An aneurysm is an abnormal widening of a blood vessel. In this case, the blood vessel is in the aorta. This is the main blood vessel that takes blood from the heart to the rest of the body. The thoracic aorta is the part of the aorta that travels through the chest.
What is going on in the body?
A weakening of the wall of the aorta can cause it to widen or swell. The larger the aneurysm, the more pressure it puts on the nearby tissues and the greater the risk of rupture. An artery that ruptures or bursts open is an emergency that often causes death.
What are the signs and symptoms of the disease?
Many people have no symptoms. A thoracic aortic aneurysm may be found accidentally as part of the testing for another problem. When symptoms do occur, may they include: The doctor may detect the abnormal eye findings or a change in the position of the windpipe. He or she may also be able to hear a heart murmur during a physical examination if the condition has affected a valve in the heart.
What are the causes and risks of the disease?
Causes of thoracic aortic aneurysm include: In many cases, the cause is not known.
What can be done to prevent the disease?
Many times nothing can be done to prevent a thoracic aortic aneurysm. Cases due to syphilis can be prevented with proper treatment early in the course of the disease. Reducing coronary risk factors can often prevent cases due to arteriosclerosis. This includes not smoking and controlling high blood pressure, diabetes, and high cholesterol, if present.
How is the disease diagnosed?
A thoracic aortic aneurysm can sometimes be seen on a regular chest x-ray. Other special x-ray tests, such as a chest CT scan, are used to detect and measure the size of the aneurysm.
What are the long-term effects of the disease?
Many people with a thoracic aortic aneurysm have no symptoms for many years. However, the long-term effects can be quite serious, and include:
Death is usually due to sudden rupture of the aneurysm. The size and underlying cause of this condition primarily determine the risk of rupture.
What are the risks to others?
A thoracic aortic aneurysm is not contagious and poses no risk to others.
What are the treatments for the disease?
Mild forms of a thoracic aortic aneurysm, especially in those who cannot tolerate major surgery for health reasons, are treated with heart and blood pressure medications. These individuals are watched closely and sent for surgery only if needed.
Surgery is the treatment of choice if the aneurysm is bigger than 5 to 6 centimetres, or roughly 2 inches wide. Surgery involves replacing the abnormal part of the aorta with an artificial graft. In some cases, one of the heart valves may also need to be repaired or replaced. The decision to perform surgery partly depends on the underlying cause of the condition. The risks and benefits of surgery should be discussed with the surgeon. Treatment is tailored to the needs of each person.
If the aneurysm ruptures, most people die within a few minutes. Those who survive are generally taken quickly to surgery to prevent death.
What are the side effects of the treatments?
All medications have possible side effects including allergic reactions. Specific side effects depend on the medications used.
Surgery is associated with a risk of bleeding, infections, and death. Paralysis, life-threatening blood clots, and allergic reactions to anaesthesia are also possible.
What happens after treatment for the disease?
A person with a thoracic aortic aneurysm that is being treated only with medications needs regular office visits to follow the condition. Any new or worsening symptoms should be reported to the doctor immediately.
If surgery is done, a period of recovery is required. The surgery is a major operation associated with many risks, but it is done to prevent death. After recovery, the person will be closely observed for leakage from the artificial graft.
How is the disease monitored?
After surgery, a person will need to see the doctor for regular visits. Someone who is treated only with medications will often have repeated special x-ray tests to watch for an increase in aneurysm size.
Author: Eric Berlin, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 15/9/2004
Potential conflict of interest information for reviewers available on request