Aortic Disease

The aorta serves as the main pathway for the transport of oxygenated blood from the heart through the body via smaller arteries. When affected by disease, the aorta can tear (dissection) or bulge (aneurysm).

Structure of the Aorta 
The aorta begins at the heart’s left ventricle and reaches up and out from the heart (this is called the ascending aorta). It then forms an arch (the aortic arch) and extends down into the abdomen (called the descending aorta).

The descending aorta has two parts:

• The thoracic aorta is the portion of the descending aorta that passes through the chest.
• The abdominal aorta is the portion of the descending aorta that passes through the abdomen.

The Aortic Wall 
The thick wall of the aorta has three layers:

• The innermost layer, called the intima, creates a smooth surface for blood to flow over.
• The middle layer, called the media, allows the aorta to expand and contract with each heartbeat.
• The outer layer, called the adventitia, provides additional support and structure.

Aortic disease has many causes, ranging from congenital (present at birth) to inherited. Aortic disease may also be caused by trauma or conditions usually associated with high levels of cholesterol or aging, such as atherosclerosis (hardening of the arteries).

The plaque that builds up inside the blood vessels in people with these conditions may lead to a weakening of the aorta, which can bulge and form an aneurysm.

Aortic aneurysms can rupture and cause bleeding that can be life-threatening. 

Several noticeable symptoms associated with aortic diseases include:

• Chest pain (angina) or tightness in the chest
• Feeling faint or fainting with exertion
• Shortness of breath, especially with exertion
• Fatigue, especially during times of increased activity
• Heart palpitations (sensations of a rapid, fluttering heartbeat)
• Heart murmur 

Depending on the type and severity of your aortic condition, your care team may use a variety of different treatment options, including:

• Medications
• Surgery
• Minimally invasive surgery
• Hybrid surgery

Medications for Aortic Disease

Medications may be prescribed to control your blood pressure and also to alleviate pain caused by your aortic condition. In some cases, beta blockers may be used to prevent arrhythmias.

For many people, medications alone can significantly slow the progression of an aortic disease, such as aortic aneurysm.

Surgery for Aortic Disease

In some cases, treating your specific aortic condition may require an open surgical approach, including:

• Aortic aneurysm repair – replaces damaged blood vessels with synthetic grafts
• Aortic root repair – replaces the damaged blood vessel wall with a synthetic tube, as well as the entire aortic root if it is diseased
• Aortic valve-sparing root replacement – used when the root is bulging but the valve leaflets remain healthy, the aortic root is replaced while maintaining aortic valve function

Minimally Invasive Surgery for Aortic Disease

Compared to open surgery, minimally invasive surgery allows for a considerably shorter recovery period and usually requires no incisions. Whenever possible, our experts will use these less invasive options to treat your aortic condition.

For instance, some aortic aneurysms can be treated via stent repair. This procedure allows the surgeon to replace the blood vessel wall, relieving pressure and preventing further bulging, by inserting a stent through a small puncture in your groin.

Hybrid Surgical Options for Aortic Disease

There are also procedures that combine open surgery and minimally invasive surgery to treat aortic conditions, such as aortic arch de-branching. During this procedure, synthetic grafts are used to reroute blood to the vessels leading from the aortic arch — preventing interruption of blood flow to the brain and arms. The surgeon also implants a stent that isolates the diseased portion of the aorta.