Aorta Heart Conditions in India : Causes, Symptoms and Treatments

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Aorta Heart Conditions

The aorta is shaped like a cane and extends up from the heart and branches off into the blood vessels, which supply the blood to the head and the arms. It descends through the chest and abdomen, where it divides into the blood vessels, which supply the abdominal organs and legs. When the wall of the aorta becomes weak, it may begin to bulge outward as blood is pumped through it. A single enlargement of an aorta is called as ecstasia. A larger bulge of more than 1.5 times the size of the normal aorta is called as an aneurysm.

Shapes:

• Fusiform aneurysm: They are the most common shape of an aneurysm and it appears as a symmetrical bulge around the circumference of the aorta.
• Saccular aneurysm: They are symmetrical and appear on one side of the aorta. Often, they are caused by a trauma or a severe aortic ulcer.

1. 1. Types of Aortic Aneurysms

There are two types of aneurysms: thoracic aortic aneurysms (TAA) and abdominal aortic aneurysm (AAA). Some people have both the types of aortic aneurysm.

a. Thoracic Aortic Aneurysms (TAA)

It develops in the part of the aorta that runs through the chest. It includes the ascending aorta (the short stem of the cane), the aortic arch (the cane handle) and the descending thoracic aorta (the longer stem of the cane).

TAA are most often caused by atherosclerosis, the hardening of the arteries that damages the artery’s walls. Very rarely, trauma like a fall or car accident can cause TAA.

Patients rarely feel any symptoms, the possible warning signs of TAA include:

1. 1. • Chest or back pain
      • Pain in the neck, jaw and upper back
      • Coughing
      • Difficulty in breathing
      • Hoarseness

Early diagnosis of TAA is critical to manage the condition. The larger the TAA the faster it grows and more likely it is to rupture. If thoracic aortic aneurysm is suspected, your doctor will order the following tests:

1. 1. • Angiography
      • Chest X-ray
      • CT scan
      • MRI
      • Abdominal ultrasound
      • Echocardiography

b. Abdominal Aortic Aneurysms (AAA)

It develops in the part of the aorta that runs through the abdomen. Most abdominal aortic aneurysms develop below the renal arteries (the area where the aorta branches out to the kidneys). Sometimes the aortic aneurysms extend beyond the aorta into the iliac arteries (the blood vessels that go to the pelvis and legs).

Over 75% of the aortic aneurysms are abdominal aortic aneurysms. This type of aortic aneurysms is most commonly found in men between the age range of 40 to 70.

There are no symptoms of an aneurysm. However, as they grow the symptoms include:

1. 1. • Prolonged pain in the back, abdomen or groin and nor relieved with position change or pain medication.
      • Pulsating enlargement or tender mass felt by a physician when performing a physical examination.

Most abdominal aneurysms are diagnosed during a routine physical examination or an X-ray when tested for other health concerns. Once AAA is suspected, the following imaging tests are used to determine the size, location of the aneurysm.

1. 1. • Ultrasound
      • MRI
      • CT scans
      • Angiogram

1. Coarctation Of Aorta

Overview: Coarctation of the aorta is a common congenital heart defect (present at birth). Coarctation comes from a Latin word “coartare” meaning “to press together”. In the coarctation of the aorta, the aorta is pinched in or narrowed either in a single location or along a portion of its length. This narrowing restricts the normal blood flow through the aorta.

Symptoms & Diagnosis:

The symptoms of coarctation of aorta depend on the severity of the narrowing. The more severe cases are often diagnosed at birth or within the first months of life. In mild cases, an individual may be symptom-free into adulthood. The symptoms in an adult include headaches, exercise intolerance, chest pain, nose bleeds, shortness of breath, cold feet or leg pain after exercise.

Aortic coarctation usually occurs between the site where the blood vessels branch off the aorta to the upper body and where the blood vessels branch to the lower body. Due to this positioning, the aortic coarctation causes high blood pressure in the arms and the upper body and low blood pressure in the lower body and legs. Therefore, the blood pressure difference is one of the most distinguishing diagnostic factors of the aortic coarctation. Your doctor may also check the other distinguishing clinical feature like hearing a distinctive heart murmur with a stethoscope placed over the patient’s back or differences in the pulse at the groin.

A cardiologist may order several different types of imaging test to help define the extent of the problem, they include:

1. 1. • Chest X-ray
      • Electrocardiogram (ECG)
      • Chest computed tomography (CT or CAT) scan
      • Echocardiography
      • Cardiac catherization
      • Magnetic resonance imaging (MRI) of the chest
   2. Aortic Disease And Marfan Syndrome

Overview: Marfan Syndrome is a condition that affects the connective tissue of the body and causes damages to the aorta, heart and other parts of the body. It is fairly common and affect about 1 in 10,000 to 20,000 people. It is found in people of all the races and ethnic backgrounds.

Causes: It is caused by a defect in the gene which encodes the structure of fibrillin and the elastic fibers that are a major component of the connective tissue. In most cases, Marfarn syndrome is inherited. It is an “autosomal dominant” which occurs equally in men and women and can be inherited from just one parent with the syndrome. People with Marfan syndrome have a 50% chance of passing it to each of their children. In 25% of cases, a new gene defect occurs due to the unknown cause. Some people may have it present, at birth, however, it may not be diagnosed until adolescence or young adulthood.

Signs: It is also referred to as a “variable expression”genetic disorder, because not everyone with Marfan syndrome has the same symptoms to the same degree. Sometimes, the Marfan syndrome is so mild, that few symptoms occur. Mostly, it progresses with age and the symptoms become noticeable only with changes in connective tissue. It causes changes to the body structure, including skeletal and dental problems. More than half of people with this condition have eye problems, changes in their heart and blood vessels and skin changes.

Diagnosis: A multidisciplinary approach is required to make the diagnosis of Marfan syndrome because multiple organ systems must be assessed. Your doctor will ask through history of symptoms and information about family members having related problems. You will be asked to undergo chest X-ray, echocardiogram, electrocardiogram, MRI or CT scan. A blood test will help diagnose Marfan syndrome as it looks for the changes in FBN1, a gene responsible for Marfan Syndrome cases.

Treatment Options:

1. 1. For Thoraic Aortic Aneurysm:

It depends on the size, location and overall health of the TAA.

1. 1. • Watchful Waiting and medications: If the TAA is small and not causing any symptoms, then your physician will recommend watchful waiting. Your physician will prescribe blood pressure medication to lower the overall blood pressure and the pressure on the weakened area of the aneurysm.
      • Surgical Repair: If the TAA is larger and causing symptoms, then you will need prompt treatment to prevent rupture. The weakened section of the vessel is removed or replaced with a graft or an artificial material. Repairing the aneurysm is a surgically complex procedure and may require an open-heart chest surgery, general anesthesia and a minimum hospital stay of five days.
      • Endovascular Repair: Instead of an open heart aneurysm repair, your surgeon may consider a newer procedure called as endovascular aneurysm repair. It is performed inside the aorta using catheters, that enter through the small incisions in the groin. They are guided and delivers a stent-graft through the blood vessels at the site of the aneurysm. The stent graft is then positioned in the diseased segment of the aorta to reline the aorta like a sleeve for diverting the blood flow away from the aneurysm.
   2. For Abdominal Aortic Aneurysm: There are two types of surgical treatments for large aneurysms:
      • Open surgical repair: A surgeon will make an incision to access the AAA. The diseased portion of the aorta is replaced with a graft that acts as a replacement blood vessel. This surgical procedure has a proven track record and acceptable risks. The average hospital stay is from 5 to 8 days. Patients can return to normal activities from 6 weeks to 3 months post operation. Discuss with your doctor about the risk of complications associated with open surgical repair.
      • Endovascular repair: During this procedure, a small fabric tube having metal stents called as stent-graft enters into your body and moved into place. First, small incisions are made in the groin to get arteries that carry blood from the aorta. The stent-graft reinforces the weakened part of the vessel from inside to create a new channel through which the blood flows and eliminates the risk of rupture. The procedure takes about 1 to 3 hours and patients can leave the hospital in 1 to 2 days. You may resume normal activities from 2 to 6 weeks.
   3. For Coarctation of Aorta:

Surgery is a gold standard treatment for the aortic coarctation. Today, treatment options for adult with this condition also include balloon angioplasty and stenting. The choice of treatment is based on the size and severity of the coarctation and its precise location and the overall health of an individual. A patient who is diagnosed with coarctation of the aorta should be under the care of an experienced congenital heart specialist. A cardiac surgeon having experience in the procedures used to treat this condition is also able to determine the optimal timing and choice of treatment.

1. 1. • Surgery: When the coarctation is relatively small, the surgeon can remove the narrowed section of aorta and re-join the two ends. This is called as an end-to-end anastamosis and it is the best surgical option for treating the condition. Other surgical options include various types of bypass surgery where the graft is stitched onto the aorta to divert the blood around the areas of the defect.
      • Angioplasty with or without stenting: This procedure is similar to angioplasty for the coronary artery disease. During this procedure, a catheter with a balloon on the end is passed into the aorta through the blood vessels, entering at the groin. When the catheter reaches the coarctation, the congenital interventionalist inflates the balloon to expand the aorta. The catheter and balloon are withdrawn when the narrowed area is fully expanded.
      • A small metal mesh tube called as a stent may be placed at the site of the coarctation to keep the aorta open after the balloon is removed. The current trend recommends stenting in case of severe, long areas of coarctation and when the difference in blood pressure persists after angioplasty. Stenting seems to lower the risk of aneurysm formation and rupture of the aorta as compared with balloon angioplasty alone.
   2. For Aortic Disease and Marfan Syndrome

The treatments for the Marfan syndrome depends on the structures affected and the severity of the condition.

1. • Lifestyle Changes: Depending on the extent of the disease and symptoms, people with Marfan syndrome can participate in some type of physical or recreational activities. Ask your cardiologist about the activity guidelines for you.
   • Medications: They will not treat the Marfan syndrome, instead they are used to prevent or control the complications. They include:
     • Beta Blocker that improves the heart’s ability to relax, decreases the forcefulness of the heartbeat and pressure within the arteries by preventing or slowing the enlargement of the aorta.
     • An Angiotensin Receptor Blocker (ARB) is a type of medication that acts as a chemical pathway in the body and often used for treating high blood pressure as well as heart failure.
   • Surgery: It aims to prevent the aortic dissection or rupture and treat the valve problems. Surgery is recommended based on the size of the aorta, expected normal size of the aorta, age, rate of aortic growth, gender, height and family history. It involves the replacement of the dilated portion of the aorta with a graft. A valve repair or replacement surgery is required when the Marfan syndrome causes a leaky aortic or mitral valve leading change in the left ventricle or a heart failure.

Why Prefer an Indian Hospital for Treating Aorta Heart Conditions?

Indian hospitals have world class infrastructure, state of the art and latest technology for treating aorta heart conditions. The Indian Cardiac Hospitals are capable to provide 24/7 care for all the cardiac conditions and emergency cardiac care. The hospitals are backed up with a team of highly qualified cardiologists and heart specialists who have experienced in performing cardiac surgeries. A better understanding of the aorta heart conditions combined with earlier detection, careful follow-up and safer surgical techniques have resulted in a better outcome for the patients.

FAQ’s

• • I’ve been diagnosed with a thoracic aortic aneurysm, but I don’t have any symptoms. Should I still be concerned?
    • Most of the time thoracic aortic aneurysm aneurysms (aneurysms in the chest) do not cause any symptoms when first diagnosed. Most of these aneurysms are instead discovered incidentally when patients undergo a chest x-ray, an echocardiogram (ultrasound examination of the heart) or a CT scan of the chest that was ordered for some other reason. Unfortunately, in some cases aneurysms may go undetected until they grow large enough that they either rupture or cause a tear that results in a life-threatening condition known as aortic dissection. The size of the aneurysm as determined on a CT is the most important piece of information in determining the need for treatment.

• • Who is affected by coarctation of the aorta?
    • Coarctation of the aorta occurs in about 1 in 10,000 births and accounts for 5 to 10 percent of all congenital heart defects.

• • What is Marfan syndrome?
    • Marfan syndrome (also known as Marfan’s syndrome or the Marfan syndrome) is a genetic disorder that predisposes to the formation of thoracic aortic aneurysms. It is due to an abnormality in the gene responsible for the formation of fibrillin-1, which is a major structural component of the fibers called elastin that give the normal aorta its remarkable strength. A defect in elastin makes the aorta weak, and a weak aorta is prone to stretch over time and become an aneurysm. Patients with Marfan syndrome are at markedly increased risk for both aortic aneurysm formation and the occurrence of aortic dissection.

• • How do I make an appointment with the best cardiologist in India?
    • All you have to do is send us your medical report and be rest assured. We will choose the best suitable surgeon for you, after consulting the experts.