Ascending Aortic Aneurysm

An ascending aortic aneurysm is a serious medical condition that occurs when the wall of the ascending aorta, the section of the aorta that rises up from the heart, becomes too weak and expands causing bulging or ballooning. The aorta is the main artery that carries oxygen-rich blood from the heart to the rest of the body.  

An ascending aortic aneurysm is not always an immediate emergency, but if it ruptures or tears, the aneurysm can be potentially fatal and induce abrupt, intense pain, low blood pressure, and loss of consciousness. 

The course of treatment for an ascending aortic aneurysm in Cuba is determined by its size and the condition’s symptoms. Small aneurysms that are not expanding quickly might only require check-ups and medications to control blood pressure. For larger aneurysms or those causing symptoms, surgery might be necessary. This may entail putting a stent to maintain the arterial wall or replacing the damaged section of the aorta with an artificial tube. The goal is to prevent the aneurysm from bursting.  

Causes and Risk Factors 

Several factors, such genetic, medical and environmental factors, can contribute to the development of an ascending aortic aneurysm, including: 

• Genetic Factors: Connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome can weaken the aortic wall and cause it to bulge. 

• High Blood Pressure: Chronic high blood pressure can put extra stress on the aorta, can cause the aortic wall to weaken and bulge. 

• Atherosclerosis: Buildup of plaque in the arteries can weaken the aortic wall and can cause it to bulge.  

• Trauma: Severe chest injuries, such a car accident, can damage the aorta. 

• Infections: In rare cases, an infection of the aorta (aortitis) can lead to aneurysms. 

• Age and Lifestyle: Aging and certain lifestyle factors like smoking can contribute to the weakening of the aortic wall, increasing the risk of aneurysms. 

Symptoms  

Many individuals with ascending aortic aneurysms may remain asymptomatic and are discovered incidentally during imaging tests for other conditions. However, as the aneurysm grows and become larger, it can cause symptoms such as:  

• Chest or back pain 
• Shortness of breath 
• Difficulty swallowing 
• Hoarseness 
• A pulsating feeling in the chest

If an aneurysm ruptures, it can cause sudden, severe pain, low blood pressure, loss of consciousness, and can be life-threatening. 

Diagnosis  

Ascending aortic aneurysm is often diagnosed during a routine physical exam or when symptoms lead to further medical investigation. In addition to medical history review and physical examination, diagnostic tests include:    

• Echocardiogram: This is a non-invasive test that uses sound waves to provide detailed images of the heart and the ascending aorta using sound waves. This test allows for the accurate measurement of the size and shape of the aneurysm, assessment of the heart’s function, and the detection of any associated abnormalities.  

• CT scan: CT scans provide highly detailed, cross-sectional images of the aorta, allowing precise measurement of the aneurysm’s size, shape, and location. The use of contrast dye during the scan enhances the visibility of blood vessels, making it easier to identify abnormalities.  

• MRI scan: MRI scans provide high-resolution images of the aorta and surrounding structures without using radiation and offer detailed information about the aneurysm’s size, shape, and exact location, as well as the condition of the aortic wall and adjacent tissues 

• Chest X-ray: Chest x-rays are used for initial diagnosis to identify patients who may require further, more detailed imaging studies. It is used as a supportive tool to detect an enlarged aorta or other abnormalities in the chest area. 

Treatment Options 

Treatment for Ascending aortic aneurysms is dependent on its size, growth rate, presence of symptoms, and the patient’s overall health. Small aneurysms that are not growing rapidly and do not display symptoms may only require regular monitoring, lifestyle changes and medication to control blood pressure. For larger aneurysms or those causing symptoms, surgery may be necessary. 

Minimally invasive repair 

Known as endovascular repair, this procedure involves making a small incision, usually in the groin, whereby a catheter is inserted into a vein, usually in the groin or arm and then guided to the heart. A stent graft, a tube covered with a fabric-like material, is then deployed through the catheter and positioned inside the aneurysm to reinforce the weakened section of the aorta. This prevents the aneurysm from expanding further and reducing the risk of rupture.   

Open surgical repair 

Open surgical repair is a traditional and widely utilized method for treating an ascending aortic aneurysm. This procedure involves making an incision in the chest to directly access the aorta, removing the weakened section, and replacing it with a synthetic graft. The graft is sewn into place to restore normal blood flow and reinforce the artery wall. Although this approach is more invasive and requires a longer recovery period compared to endovascular repair, it is highly effective and offers a durable solution for preventing aneurysm rupture.