Does Your Aorta Need Surgery?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy!

Patrick Vargo, MD:

Hello, my name is Patrick Vargo. I'm one of the heart and aorta surgeons here at Cleveland Clinic. I operate on the heart, the valves, the coronary arteries, as well as the aorta that comes out of it. The aorta is the biggest blood vessel in the body. It carries blood out of the heart to all the organs and all the limbs of the body. And as it travels through the body, it rises in the chest to the top and then arches towards your back and runs along your spine. And all along the way it gives off branches.

The portion of the aorta that runs along the spine on the chest is called the thoracic aorta, and in the abdomen is called the abdominal aorta. Aneurysms and dissections and diseases of the aorta can affect one, the other, or both as the aorta is just one continuous tube.

One thing that can affect the aorta is a weakening of the walls. And what happens is the aorta dilates and balloons up and becomes larger in diameter than it should be. When this happens, the aorta is at risk for a rupture or tearing. An aortic tear is often called a dissection in the medical vocabulary. A dissection is when the layers of the aortic wall peel apart and blood travels through the wall of the aorta, creating a false passageway or a false channel. This can cause blood flow not to get to many organs or not to get to different parts of the body. It can also cause the aorta to weaken so much that it does rupture, and when the aorta ruptures, you have internal bleeding that can be life-threatening, that could cause you to die or have serious disability.

So, when aortas start to get big, and we find them on imaging like CAT scans or echocardiography or ultrasounds. When they get to a certain size, we often choose to go in and replace them before they have a rupture or before they have a tear. That can mean open heart surgery if it's on the part of the aorta that's very near to the heart. It could also mean surgery from the side or from the belly if it's in the aorta that runs along the spine. And increasingly, we're able to fix these aortic aneurysms and aortic tears with stents.

The stents we insert through small incisions or small nicks in the groin. In those situations, the stent helps to re-line the inside of the aorta and cover the tears or seal off the aneurysms. Whether it's an open surgery or a stenting surgery depends on where the aneurysm or the tear in the aorta is and the shape of it.

Things that cause aneurysms are variable. They oftentimes run in families. They can be genetic disorders, things that you inherit, things like Marfan syndrome, Ehlers-Danlos, Loeys-Dietz. Or many times we don't have a name for a gene abnormality that passes along a risk for an aneurysm, but we do see them cluster in families. So, we recommend that first degree relatives, that's your brothers, children, sisters, parents, people in your immediate family, if someone is diagnosed with an aneurysm or an aortic dissection, we recommend those people get screened with a CAT scan or an echo or an ultrasound to see if they also have an abnormal aorta. There's also genetic testing that can be done with a blood test if it's warranted.

Other things that can cause aneurysms or dissections are things like inflammatory autoimmune disorders, things we call aortitis when the wall of the aorta actually gets inflamed. Infections can be associated with aneurysms, as well, if they cause an injury to the wall of the aorta, and otherwise just things like atherosclerosis or hardened blood vessels from things like smoking, diabetes, high blood pressure. The causes are numerous and oftentimes they're multifactorial, meaning that there can be contributions from each one of these things that I've mentioned.

Also, what's interesting to talk about is the aortic valve, which is at the base of the aorta as the aorta joins the heart. So as blood comes out of the heart and passes into the aorta, there's a valve that separates the two, and it's a one-way valve that prevents blood from going backwards into the heart. This is called the aortic valve. Oftentimes, if you have a bicuspid aortic valve, you may also have an aneurysm or a dilated aorta. Around one-third to one-half of people with a bicuspid aortic valve also have a dilated or aneurysmal aorta.

Bicuspid means two cusps. The normal aortic valve has three cusps and 1 to 2 percent of the population when they're born, they may have a fusion of two of those leaflets and only have two cusps. And that is also something that runs through families. So, if you know that you have a bicuspid valve or you know someone in your family has one, that is also something to tell your family doctor or your cardiologist. The valves can wear out early. They can get leaky, or they can get stenotic, meaning narrowed and hardened with calcium. And those may be reasons that we have to do heart surgery, as well.

Cardiac surgeons are experts at blood vessels in the chest. That includes the heart, the valves, the coronary arteries, and also the aorta in the chest. When the aorta leaves the chest and goes into its branches, into its organs and limbs, oftentimes a vascular surgeon or a surgeon that operates on the peripheral blood vessels, the abdominal aorta and sometimes helps with the thoracic aorta and along the spine, may also be someone that you need to see if you have a problem with those areas.

Together, especially here at the Cleveland Clinic, we have a multidisciplinary aorta team, where we have heart surgeons and vascular surgeons that work on the aorta as it travels through the body, and in those places where it overlaps the chest and the abdomen, we work closely together and work in teams to repair blood vessels in this area.

So, thank you for joining me today. It was my pleasure to speak with all of you. And if you have any questions or concerns, please don't hesitate to reach out to your family doctor, your cardiologist, or a surgeon that you think you need to see.

Announcer:

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