Aortic disease

Overview

At Guy’s and St Thomas’ Specialist Care we offer the expertise of a multidisciplinary aortic team that manage patients with diseases of the thoracic aorta.

Types of aortic disease

The thoracic aorta is the largest artery in the body. Two aortic diseases treated by our specialist team include aortic dissection and aortic stenosis.

Aortic dissection

Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta, forcing the layers apart.

Immediate treatment is required for aortic dissection as it can quickly lead to death, even with optimal treatment, as a result of decreased blood supply to other organs, heart failure, and sometimes rupture of the aorta.

Aortic stenosis

Aortic stenosis is the narrowing of the exit of the left ventricle of the heart such that problems result.

Stenosis due to calcification is the commonest pathology of the aortic valve. When severe it results in hypertrophy (enlargement) of the heart muscle and symptoms such as shortness of breath and chest pain.

Aortic disease symptoms

Symptoms of aortic dissection

In the majority of cases patients will experience a sudden severe pain, that may be described as tearing, stabbing, or sharp in character. The location of the pain is associated with where the dissection has occurred – it may be felt in the chest, back or it may cause sharp pain when breathing.

Symptoms of aortic stenosis

Aortic stenosis may not present any symptoms in its earlier stages, and is normally picked up with diagnosis of other diseases.

When the disease progresses the following symptoms may present:

• chest pain
• feeling tired or short of breath after exertion that you would normally be fine with
• heart palpitations (abnormal heartbeats)
• developing a heart murmur (can be described as a ‘swooshing’ sound, heard in the heart as it beats)

What causes aortic disease?

Causes of aortic dissection

It is more commonly found in patients with the following risk factors:

• history of high blood pressure
• a known thoracic aortic aneurysm
• those with connective tissue diseases that affect blood vessel wall integrity such as Marfan syndrome and Ehlers–Danlos syndrome

Causes of aortic stenosis

Aortic valve stenosis may be present at birth, develop due to rheumatic fever, or from calcification of the valves. Men have a higher risk than women, with the condition most likely to occur between the ages of 60 to 80.

Aortic disease treatment

How is aortic dissection treated?

The treatment for aortic dissection will depend on the type of dissection, the severity and the patient condition.

Proximal aortic dissection (Type A)

The dissection that starts in the ascending aorta (nearer to the heart) is the more life-threatening variant and will normally require surgical intervention. However it can affect middle age and very old patients who are at a high surgical risk. Catheter based endovascular repair may be an option the aortic team would consider in these cases.

Type B aortic dissection

This type of dissection starts in the descending aorta, and can be managed medically in a number of cases. Endovascular treatments, both in the acute setting and in the elective setting, are also proving to be a successful alternative resulting in improved survival and delayed disease progression.  The idea is to remodel the aorta and thereby avoid future problems.

For example the aortic team offer thoracic endovascular aortic/aneurysm repair TEVAR. This involves the placement of an expandable stent graft within the aorta without operating directly.

For those living with aortic dissection – a helpful website, Living with Aortic Dissection has been designed with the assistance of one of our consultants, Professor Christoph Nienaber.

How is aortic stenosis treated?

Medications can be used to help manage the disease, for example blood pressure medication, to reduce the burden on the valves.

A number of surgical approaches are available to repair or replace the damaged valve and have a high success rate, dramatically improving quality of life.

Aortic Valve Replacement (AVR)

This is the highest standard for treatment of aortic valve stenosis.

Sutureless AVR

This is an alternative to both conventional AVR and transcatheter aortic valve implantation (TAVI).

Other treatments for aortic disease

The aortic team carries out various surgical treatments and procedures for conditions relating to the aorta.

Surgical treatments

• surgical replacement of aortic valve including ascending aorta and arch
• complete arch solutions including frozen elephant trunk
• rerouting and debranching procedures
• carotid endarterectomy

Hybrid procedures

• simultaneous or staged surgical debranching and interventional stent-grafting of arch aneurysm
• thoracoabdominal hybrid procedures (combining surgical and endovascular components)

Endovascular procedures

• interventional reconstruction of aortic dissection (TEVAR/ stent-grafts and/or stents)
• endovascular exclusion of aneurysms of the aorta or major vessels (TEVAR/EVAR)
• stenting of occluded or stenosed arteries
• nonsurgical treatment of adult coarctation