It’s shaped like an inverted hockey stick and ends near the base of the spine by dividing into two branches to the legs.
Aneurysm means a localized outpouching or swelling of an artery. Aneurysm of the Aorta can be localized to the chest and is termed Thoracic Aortic Aneurysms, or in the abdomen, it is termed Abdominal Aortic Aneurysms.
It’s best to understand aortic aneurysms with a balloon metaphor. When a balloon is not dilated (not blown up), it requires a lot of force to commence dilatation. However, once a balloon becomes slightly inflated, it becomes easier and easier to make it bigger. Over time a balloon that has become bigger than a certain limit would rupture.
Similarly, once a small bulge or aneurysm develops in an artery, it becomes easier for that artery to dilate further and further. At a certain time, it becomes big enough to pose an imminent risk of either creating a tear in its wall (dissection) or a frank rupture. Both aortic dissection and rupture are life-threatening emergencies, and untreated would be fatal in most circumstances.
The goal of your doctors is to keep a close watch on the patient’s aorta by regular follow-up scans and operate before a life-threatening emergency develops.
Risk Factors for Aortic Aneurysm formation:
- Inherited conditions (Marfan syndrome, Loeys-Dietz syndrome)
- Chronic or untreated high blood pressure
- Atherosclerosis (hardening of the arteries)
- Injury from major road traffic accidents or fall from height.
These conditions have the potential to weaken the wall of the aorta, allowing it to dilate over time. Remember that cigarette smoking is an important risk factor, and patients with the dilated aorta and their blood relatives should consider quitting smoking.
Symptoms and diagnosis of Aortic Aneurysm:
Aneurysms often remain unnoticed till they grow to a substantial size. Then they can cause symptoms due to leakage of the aortic valve, like shortness of breath and palpitations. They can also cause pressure symptoms like aching or pain in the upper back, difficulty breathing due to pressure in windpipes, and sometimes hoarseness of voice because of a stretch of nerves operating the vocal cords.
Sudden tearing pain in the upper chest rapidly progressing to the back and sometimes down the spine is a hallmark of aortic dissection and, as mentioned above, is a life-threatening emergency.
Most aneurysms are diagnosed on scans carried out for other medical conditions. Often an X-ray of the Chest would reveal an abnormal shadow in the region of the aorta. They can also be discovered on CT, MRI scans of echocardiograms. A rare aortic aneurysm can penetrate the bones of the front of the chest and present with pulsating swelling in the front of the chest.
Whenever a small aneurysm is diagnosed, then a regular scan of the aorta is performed at 6-24 months intervals to define the rate of increase in size and its dimensions. These two measures define the timing of surgery.
Surgery for Aortic Aneurysm:
These are some of the most intense surgeries in the cardiac field. The patient’s chest is entered in the appropriate location, and the heart is always bypassed using a heart-lung machine.
In brief, we need to remove the dilated segment and replace it with a synthetic Dacron tube. The surgeon must ensure that the circulation of the heart, brain, spinal cord, and the entire body is protected during surgery and reconnected to the new circulation before the operation is terminated.
Surgeons often use additional measures like hypothermia to protect the body and the brain and intermittently deliver nutrient-rich blood to the heart during these complex surgeries.
For some patients and in certain locations of the aorta, we can also insert covered stent-grafts inside an aneurysm by complex aortic stent procedure.
Recovery and rehabilitation after surgery
A normal recovery pattern is followed after any open chest procedure, and most patients are discharged within 4-6 days after surgery.
- First 2 days
All patients are provided with proper care in an intensive care unit for the first two days after surgery. A dedicated specialist cardiac surgery postop care nurse is with the patient 24×7. Monitoring each and every vital parameter and looking after Pulse, BP, variety of pressures from within the heart chambers, lung function whether the patient is breathing by a machine or by themselves. Kidney, liver, brain functions, need for blood transfusion and intravenous fluids, etc are also monitored. There is a dedicated Cardiac Surgery and a Cardiac Anesthesia Doctor in the hospital only for Cardiac Surgery patients to supervise the nurses. I am also available around the clock for any issues for which doctors or nurses might seek advice.
- Next 3-5 days
Most patients start walking to the bathroom before this stage, food progressively becomes more interesting, and they are shifted to the SICU or ward depending upon many clinical factors. While nurses and doctors are always around, this time is spent making patients more and more independent for their daily needs.
- Day of discharge
The patient and their relatives are educated in a rehabilitation class by a rehabilitation expert. All patients learn to get in and out of bed unsupported. Patients are expected to travel home by car, sitting in the front seat with a towel between the chest and seat belt. All patients are asked to climb stairs and not be carried in chairs as makeshift palanquin.
Bathing as suggested by doctors and nurses onwards. Exercises as per the embedded video.
- First Review after a week
Some blood tests, an ECG, and CXR are required at this clinic attendance. Most patients can start short walks in the local parks and increase exercise.
- A month after surgery
Most self-employed people who can control their timings are back to work by this time; people in employment need about 2 months to regain strength.