Ascending Aortic Aneurysm: A High-Risk Area, Close to the Heart

The aorta is the main blood vessel that provides blood to the rest of the body. When you get an aneurysm in your aorta, it can enlarge to the point of rupturing. An ascending aortic aneurysm happens very close to the heart, which is a high-risk area. The Aortic Center at UVA has the expertise and experience needed to excel in aneurysm repairs. Cardiac surgeon Kenan Yount, MD, walks us through the causes, treatment options, and recovery process of ascending aortic aneurysm repair.

Transcript

The aorta is the main blood vessel that comes off the heart. And the very first part thatcomes off the heart above the aortic valve is the aortic root, followed by the ascending aorta. And so that area of the aorta right next to the heart is obviously high-risk territory.

An aneurysm simply means that the aorta is larger than normal. And we know from studies and real-life experience that larger blood vessels are more prone to both rupture or tearing. Tearing, medically, we call a dissection.

We frequently will do surveillance on aneurysms for several years, and try to look at the rate of growth that the aneurysm displays on CT scans. Or we also may instead look at the absolute size criteria of the aorta. And that gives us a good guide as to when to replace the aorta. And we try not to replace it any sooner than we have to, balancing the risk of doing a surgery against the risk of the aneurysm rupturing.

If untreated, an aneurysm can sometimes enlarge to the point where it is likely to rupture or tear. In either of those scenarios, it could be life-threatening if one of them were to happen before we had a chance to replace the aorta.

Ascending aortic repair is probably one of the largest procedures a patient could have, and it can be very complex, depending on the extent of the aneurysm. Over the years, we've made a number of advances in how we both protect the heart and the brain during these surgeries. UVA is really at the forefront and leading the advances of both cardiac protection and cerebral perfusion.

Ascending aortic repair can take anywhere from four to five hours. Patients frequently go to an intensive care unit for the first night or two after their operation where they're closely monitored, and then they can recover for about another three days on a regular ward bed. Overall, recovery can take anywhere at home from four to six weeks. And usually we try to start cardiac rehab at the six-week mark to get patients back on their feet and going again.

Given both the risk of stroke and the risk of cardiac damage during these procedures, UVA is ideally suited to providing both surgeries, be it open surgery or interventions which are more minimally invasive. We have a fair amount of expertise collected over the past 20 to 30 years that have allowed us to do this in a much safer fashion than the surgeries used to be done.

[vaheemmian]

My name is Vahe Emmian and this is my story.

At 45 (27 years ago), in Montral Qc, doctors found that I had an ascending aorta aneurysm of 9 cms! (my only symptoms were fatigue, short breathness and sometimes, slight chest pain.
Drs replaced the section of the aorta and the aortic valve with metal ring and dacron, I think.
I recuperated relatively well, without major physiotherapy
3 years later, I had a pseudo-aneurysm (the original aneurysm failed and blood ran in a cavity behind the heart and formed a PA.
My doctor was hesitant first because of reopening my chest and the risk of rupturing the PA, but following mutual assessement, said he would do it.
3 months later, I had a minor heart attack (right ventricular coronary) and recuperated well.
In 2012, I suffered yet another situation (called widow maker!) qusy obstruction at the forking of the coronary on the heart.
My new young surgeon assessed my history and proposed a less invasive operation: entering under my left arm and proceed with a double bypass, in situ, without extra- sanguinating(?) procedure. I later heard that it was his expertise!
He told me that all what I have gone through is due to the original size of the main aneurysm, which had damaged the surrounding tissue.
In 2018, I yet went to a major operation called 'redo' which us basically starting all over again replacing the aging aorta section and the valve...
Except, this time was not as easy: 3 surgeons, 17 hours under the scalpel, enormous amount of blood loss, heart electrical system collapse (I'm with a pacemaker now),
in the coma for several days, all internal organs failed but recuperated eventually, total weakness for weeks, but here I am still ticking and kicking...

Do not dispair and believe in the medical advances and THINK POSITIVE and LOVE LIFE, someone is probably watching on you.

[vasilkasassie]

My aorta ruptured in 2017, I was airlifted to Henry Ford hospital in Detroit. I was in a coma for a week after surgery and in the hospital for a month. I am so grateful to my cardiovascular surgeon who safed my life.

[kimmyflink]

I have an ascending aortic aneurysm size 4.3 when initially discovered. Actually I thought I was just gonna die right then and there.
Already have fibromyalgia and suffer chronic pain so totally not wanting any type of surgery. Last catscan measured 4.1 what the heck, these don’t shrink.
Must be God shrinking it up

At any rate I just try to go about my normal life, we’re all gonna go at some point. The hardest part with this thing is limitations. On my good days I like to garden to include digging, lifting and when no ones around to help it stinks lol

I wish you all well, peace and healing and successful procedures whatever they may be. 🎉❤

[Adam]

@2:30 I worked until 8/13/2013. I had my friends at work wishing me good luck, and so on. However, what I remembered the most was guys who did tours in Iraq or Afghanistan or both coming to me wishing me luck, but also asking me if I was scared about the surgery. I replied with a no, and asked why? They said, "well, you're having open heart surgery tomorrow, I know I would be." I said back, if I do nothing I have a 100% chance of dying. But, if I have the surgery to forgo that situation, I only have a 5% chance, as a gambler I like those odds.

[bennettdickmann]

This physician explained the seriousness of an aortic aneurysm while doing it in a calm and assuring manner.

[Adam]

@1:36 Mine didn't rupture. I caught some warning signs mostly (sweating, extreme fatigue, and some annoying heart beats that were not picked up on by the halter monitor). My initial read was a 4.7 unclear read, and I was immediately scheduled for a nuclear dye scan which showed a reveal of 5.4 and my surgery to correct was schedule for 8/14/2013, and I was 34. I only had two issues with surgery, well three if you include me finding out I was allergic to tramadol and refused to take it in the hospital. I had suffered from CO2 poisoning twice, and that hurt me and my lungs more than the surgery. Finally, I was thought to be having an infection due to fever, when it was the hospital forgetting to put the AC in in the summer time.

[Oldspartan]

I told my dr. About the type of operations for Aneurysms they show on youtube he said they were crap and to stop watching them I believe him

[alainpaum]

Whaht should i do i have an aneurism situated on the arch of the aorta measuring 86 mm ! I was told that it would be dangerous to be operated because i could end up paralyse ! What the hell ! Plus i do not have money to go to hospital ! What the heck !

[afritimm]

Is the less invasive surgery possible for repairing an ascending aortic aneurism?
Or is open heart necessary? I know its location has made it difficult in the past.
But maybe techniques have improved?

[englelisa]

The study was technically limited.
• Heart Rhythm: sinus rhythm.
• Normal chamber sizes.
• The left ventricular global systolic function is normal. No left
ventricular segmental wall motion abnormalities identified, but
endocardial definition is suboptimal.
• Valves poorly visualized, by color/ Doppler, no obvious significant
abnormalitites
• The aortic root is grossly normal in size at the sinuses of Valsalva.
The ascending aorta is mildly dilated. Ascending aorta measures 4.1 cm@
3.1 cm distal to STJ
• The inferior vena cava is not well visualized, probably at least mildly
dilated
• Compared with prior report dated 1/28/2022: ascending aorta was not
visualized on prior study
I am a 56 year old woman with a bmi that is 66.
Do you think it would be safe to have weight loss surgery?

[JorgeFouto]

I have one 3.9 xm, root ascending anneurysm. I am not quite there yet for suggery, but i am super scared of everything i read. I really want to avoid open heart surgery!! It seems that for abdominal and descensing torax ones, there non invasive solutions....what about for ascending aortic anneurysms, does anyone know of new or possible minimally invasive procedure?

[harveyharber]

My mum is going to have open heart surgery and she has a 10% chance of death, ik it doesn't sound like alot, but still worried I can't lose her and I'm only 17😣

[deionamuhammad]

Can a rupture happen in over a year after a 4.0 cm diagnosis? Diagnosed 2021.

Is it also possible for an MRI to be given 5 years before the diagnosis in 2021 and for the 4.0 cm aortic aneurysm to be missed by the MRI?

I went to the doctor from 2009 through 2017 with chest pains, vomiting and heart attack symptoms and I was given an chest MRI once around 2013-2015 . Nothing seen until 2021.

[Shayan-obiv]

Plz tel me doc my ascending aorta annyrisam is 45mm Plz sajest me sargari yes or no.answer Plz. Any time chest pain

[englelisa]

Can I have weight loss surgery if I have Ascending aorta measures 4.1 cm@ 3.1 cm distal to STJ ?

[omamendiola]

Hi dr.i was diagnosed of Thoracic Aortic Aneurysm its size is 4cm.am i safe or go with open heart surgery...

[michaelkruz]

They found an aneurysm on my heart 2 years ago 4.9 cm. What symptoms do I need to watch for and what I need not to do for it to rupture or grow?

[DanielleA]

Drs these days speak so coldly about life impacting detrimental conditions we suffer today