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Thoracic Aortic Disease

The Barnes-Jewish & Washington University Heart & Vascular Center offers specialized care for patients with thoracic aortic diseases. There are several diseases of the thoracic aorta which can weaken the wall of this major blood vessel. These are known as thoracic aortic aneurysm (TAA), aortic dissections and aortic ulcerations. In our center, a multidisciplinary approach to the evaluation and management of thoracic aortic disease is offered, involving specialists from cardiac and vascular surgery, cardiology, medical genetics and radiology.

Thoracic aortic aneurysms may be related to hypertension, bicuspid aortic valves, inflammatory conditions, trauma or an underlying genetic disorder, such as Marfan syndrome, Loeys-Dietz aneurysm syndrome, Turner syndrome, familial thoracic aortic aneurysm and dissection syndrome, and vascular Ehlers-Danlos syndromes. Successful management requires expert diagnosis and appropriate treatment and follow-up. Proper therapy can often be life-saving.

Understanding Thoracic Aortic Aneurysm

The heart pumps blood directly into the thoracic aorta, and the aorta then acts as a pipe to deliver blood to other blood vessels throughout the body. Weakening of the wall of this blood vessel causes the aorta to bulge, and this bulge is known as a thoracic aortic aneurysm (TAA). If the blood vessel wall becomes severely weakened it can burst or dissect (tear). Aortic dissection and aortic rupture may be fatal and require emergency care at a center with expertise in the care of patients with these conditions. It is important to recognize and treat thoracic aortic aneurysm before a life-threatening complication occurs.

Most thoracic aortic aneurysms do not cause symptoms and are not detectable on a routine physical examination. Thoracic aortic aneurysms may be uncovered by chest X-ray, but imaging such as echocardiogram, CT scan and MRI scan are necessary for complete evaluation. Aneurysms may cause chest or back pain which could be a sign that the wall is too weak to support the pressure of the blood inside. Aneurysms associated with pain may pose a particular risk of rupture and should be evaluated promptly by a specialist.

Treating Thoracic Aortic Aneurysm

Tremendous progress has been made in recent years in the treatment of aortic aneurysms. Some small aneurysms do not require surgical repair but may require treatment with medications to lower blood pressure. If surgery is not necessary, the aneurysm is routinely checked by echocardiograms, CT and MRI scans to monitor its growth. To prevent the rupture of a large aneurysm, the weakened wall needs to be replaced with stronger tubing.

There are several different options for thoracic aneurysm repair. An open aneurysm repair is performed through a large incision in the chest, and the surgeon directly replaces the diseased portion of the aorta with a fabric-covered tube which is sewn into place. Endovascular aneurysm repair uses smaller incisions in the lower abdomen or groin, and the tubing is advanced into the aneurysm using x-rays to direct the surgery. Not every patient can be treated with an endovascular aneurysm repair. However, compared to open surgery, endovascular aneurysm repair often results in quicker recovery following surgery. Endovascular repair may be helpful in treating high-risk patients who cannot be treated with open aneurysm repair.

Thoracic aortic aneurysms are uncommon, and not every surgeon has significant experience in repairing them. The surgical outcomes are best and the risks are lowest in centers such as the Barnes-Jewish & Washington University Heart & Vascular Center. Our cardiac and vascular surgeons have extensive endovascular experience, successfully performing procedures with this new and evolving technology. We have participated in the evaluation of all approved devices and continue to work closely with device manufacturers to improve the designs of the next generation of devices. As one of the leading heart and vascular centers in the country, we also offer the opportunity for patients to participate in the latest endovascular trials. Our center also participates in the International Registry of Acute Aortic Dissection and the Valve-Sparing Aortic Root Replacement Registry in Marfan Syndrome.

To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call 855.925.0631.