Aortic aneurysm and dissecting repair
An aortic aneurysm is an enlargement or dilatation of a part of the body’s major blood vessel, the aorta. If the aorta becomes too large, it may be at higher risk for rupturing (bursting) or tearing (aortic dissection), requiring emergency surgery to repair it. We aim to find and repair these aneurysms before these emergencies occur to reduce the risk to our patients as much as possible.
An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect).
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2 Different types of Aortic Dissection
There are two main types:
- Stanford Type A Aortic Dissection: This type of dissection occurs in the first part of the aorta, closer to the heart, and can be immediately life-threatening. It usually requires emergency open chest surgery to repair or replace the first segment of the aorta where the tear started (ascending aorta +/- the arch and/or aortic valve). This is a more common type of dissection than Type B, and the dissection of the aorta usually extends through the entire length of the aorta.
- Stanford Type B Aortic Dissection: This type of tear begins farther down the aorta (descending aorta beyond the arch), and farther from the heart. Like the type A dissection, this usually extends from the descending aorta into the abdominal segment (abdominal aorta), but doesn’t involve the first part of the aorta in the front of the chest. Surgery may or may not be needed immediately, depending on exactly where the dissection is located and if it is or isn’t cutting off blood flow to your organs. These operations usually can be performed with a stent-graft device inserted into the aorta.
Another classification system (DeBakey Classification) defines dissection by three types. Type 1 originates in the ascending aorta and extends through the downstream aorta. Type 2 originates and is limited to the ascending aorta (both would be considered Stanford Type A). Type 3 originates in the descending aorta and extends downward (similar to Type B).
Signs and Symptoms of Aortic Dissection
The most common characteristic of aortic dissection is its abrupt start. It can happen at any time, while doing anything, at rest or when you’re sleeping.
Common signs and symptoms include:
- Sudden severe, sharp pain in your chest or upper back; is also described as a tearing, stabbing, or ripping feeling.
- Shortness of breath.
- Fainting or dizziness.
- Low blood pressure; high suspicion when there’s a 20 mmHg pressure difference between arms.
- Diastolic heart murmur, muffled heart sounds.
- Rapid weak pulse.
- Heavy sweating.
- Loss of vision.
- Stroke symptoms, including weakness or paralysis on one side of your body, trouble talking.
What complications can result from Aortic Dissection
Aortic dissection can lead to:
- Aortic valve damage.
- Damage to internal organs.
- Fluid buildup between the heart muscle itself and the sac covering the heart. This condition, called cardiac tamponade, puts pressure on the heart and prevents it from working properly.
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Manipal Hospitals maintains its leadership position in cardiovascular medicine by providing high-quality patient care and the latest and best surgical options – including minimally invasive heart surgery.
85% of patients who have undergone successful repair of acute dissection involving the ascending aorta remain alive at 5 years. Patients who were more than 70 years of age or had developed stroke, coma or kidney failure after the operation were at increased risk for death during the follow-up period.
- Push, pull, bear down or lift anything heavier than 30 pounds (or 10 pounds for patients recovering from surgery).
- Get a tattoo or body piercing.
- Smoke (or be exposed to secondhand smoke) or use any other tobacco products.
- Shovel snow, chop wood, dig earth or use a sledgehammer or snow blower.
- Take illicit drugs.
If you have a larger aneurysm and are getting closer to repair, it’s still ok to stay active. These activities are usually safe to do, he says, even with a growing aneurysm: Moderate exercise, like walking, cycling or swimming.