Thoracic Aortic Aneurysm

GENERAL INFORMATION:

What is a thoracic aortic aneurysm? Thoracic (tho-RAS-ik) aortic (a-OR-tik) aneurysm (AN-u-rizm), or TAA, is an abnormal widening of a part of the thoracic aorta. The thoracic aorta is the large artery (blood vessel) that comes from the heart and extends down the center of your chest. It contains blood with oxygen that goes to the rest of the body. TAA occurs when weak spots in the walls of the blood vessel are present. It commonly forms in the first part of the thoracic aorta but may happen in other parts of the blood vessel.

What causes a thoracic aortic aneurysm? TAA happens when spots in the walls of the aorta become weak and the pressure inside it increases. The following are possible causes of TAA:

• Abnormal development: This means that your aorta may not have grown normally, such as in a bicuspid aortic valve. A bicuspid aortic valve has only two cusps (flaps), instead of the normal three. This causes the blood to flow back to the heart and increases pressure.
  
  
• Aortic dissection: Aortic dissection is a tear in the aorta. This causes blood to flow in between the layers of the aorta's wall.
  
  
• Atherosclerosis: Atherosclerosis is the hardening of the arteries. It usually occurs when fatty deposits, called plaques, build up along the walls of your arteries.
  
  
• Inflammation: The walls of the aorta may become inflamed (swollen) due to certain inflammatory diseases, such as Takayasu's arteritis. It may also be as a result of an infection, such as syphilis. With syphilis, parts of the aorta's wall gets damaged and weakens.
  
  
• Loss of elasticity: Cystic medial degeneration may cause TAA. This usually occurs as a result of aging. With age, the blood vessels in the body may lose some of their elasticity. This may be worsened by increased blood pressure. Certain disorders, such as Ehlers-Danlos syndrome and Marfan syndrome, may make the walls of your arteries lose elasticity.
  
  
• Trauma: Injury, particularly on the chest area, may lead to a partial or complete cut in the aorta.

What increases my risk of having a thoracic aortic aneurysm? The following may put you at higher risk of having TAA:

• Being overweight (weighing more than what your caregiver suggests).
  
  
• Cigarette smoking.
  
  
• Diabetes (high blood sugar levels).
  
  
• Having a close family member with TAA.
  
  
• Hypertension (high blood pressure).
  
  
• Male and over 65 years of age.

What are the signs and symptoms of a thoracic aortic aneurysm? Signs and symptoms depend on what part of the thoracic aorta was affected. The size of the aneurysm and its effect on the organs around it are also important. When the aneurysm is big, the parts around it may be squeezed. Signs and symptoms of TAA may include any of the following:

• Chest, neck, back, or abdominal (stomach) pain.
  
  
• Cough or blood in sputum.
  
  
• Heart murmur (abnormal changes in heart sound).
  
  
• Hoarseness.
  
  
• Trouble breathing which may be affected by position.
  
  
• Trouble swallowing.
  
  
• Wheezing (high-pitched noise when breathing).

How is a thoracic aortic aneurysm diagnosed? You may need tests to show your caregivers where and how big your aneurysm is. Certain tests use a special dye to help the aneurysm show up better. Tell caregivers if you are allergic to iodine or shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. One or more of the following tests may be done:

• Computed tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your chest area. Before taking the pictures, you may be given dye through an IV in your vein.
  
  
• Magnetic resonance imaging: This test is also called an MRI. An MRI uses a large magnet and a computer to take pictures of your body. During the MRI, you may also have a test called magnetic resonance angiography or MRA. You will be given dye if MRA is to be done. MRI and MRA help caregivers see the size of your TAA.
  
  
• Transesophageal echocardiogram:
  
  
  • A transesophageal echocardiogram (TEE) is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for certain problems such as blood clots or infection inside the heart.
    
    
  • You will be given medicine to relax you during a TEE. Caregivers put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.
  
  
• X-rays: Caregivers may take x-ray pictures of your chest. These may show your lungs, heart, aorta, and other parts around them. Before the x-ray, you may be given dye through an IV. An x-ray of the aorta with dye is called an aortogram or aortography.

How is a thoracic aortic aneurysm treated? Treatment of your TAA may depend on your age, the location and size of your TAA, and your health. If the aneurysm is small and produces no symptoms, watchful waiting may be all that is needed. You may also need one or more of the following:

• Medicines: You may be given medicine to slow the growth of your TAA and decrease the risk of rupture. You may also need medicine to control other problems, such as high blood pressure.
  
  
• Surgery: You may need surgery if the aneurysm is too big, causing serious symptoms, or is likely to rupture. An aneurysm that is getting bigger or becoming worse may need to be treated with surgery as soon as possible. During surgery, caregivers may repair the aneurysm using a man-made tube graft. A stent (tube) may also be put in the portion of the aorta with the aneurysm. This will serve as a tunnel for the blood to flow through. Through stenting, the portion with the aneurysm is strengthened and prevents an increase in pressure.

Where can I find more information? Having a thoracic aortic aneurysm may be life-changing for you and your family. Accepting that you have TAA may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas, TX 75231-4596
  Phone: 1-800-242-8721
  Web Address: http://www.americanheart.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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