What is a Thoracic Aortic Aneurysm?
The aorta is the main artery supplying oxygen-rich blood to every part of your body. It starts in the lower left heart chamber (left ventricle), goes up toward the brain, then curves down and extends into the abdomen.
When the aorta wall is weakened or damaged, it can begin to balloon outward in the damaged area. This abnormal bulge is called an aneurysm. Blood can pool in the aneurysm, causing it to rupture, or the aorta wall can tear (aortic dissection). There are three types of aneurysm:
- Thoracic aortic aneurysms occur in the parts of the aorta that are in the chest cavity. These include the aortic root (where the aorta connects to the heart), the ascending aorta near the heart, the part of the aorta that curves and the part of the aorta that descends towards the abdomen. Penn Medicine's cardiac surgeons provide care for aneurysms that occur in the chest.
- Abdominal aortic aneurysms occur in the part of the aorta that is below the diaphragm. If you have this type of aneurysm, the Penn Vascular Surgery and Endovascular Therapy team will provide your care.
- Thoracoabdominal Aortic Aneurysms extend from the chest to the abdomen. Cardiac surgeons work collaboratively with vascular surgeons to manage these aneurysms.
Symptoms of Thoracic Aortic Aneurysms
Because aortic aneurysms develop slowly over years, doctors discover most of them before they tear open or leak blood. Your medical provider may discover a thoracic aortic aneurysm when they order imaging tests for another reason. Most people don't experience symptoms when aneurysms are small.
A large or rapidly expanding aneurysm that tears (dissects) or leaks blood may be accompanied by symptoms including:
- Pain: This can include sudden, severe or constant jaw, neck, chest or back pain that isn't relieved by movement or pain medicines.
- Difficulty breathing: You may have difficulty catching your breath or have frequent fits of coughing. Some people have a hoarse voice that has no obvious explanation.
- Rapid heart rate: You may notice your heart is beating rapidly and that you have clammy skin.
Diagnosing Thoracic Aortic Aneurysms
Your doctor may use active surveillance to watch for the development of an aortic aneurysm if you have:
If your Penn cardiac surgeon is screening for or suspects you have a thoracic aortic aneurysm, they will likely use advanced cardiovascular imaging tests such as:
- Heart ultrasound (echocardiogram)
- Chest X-ray
- CT or MRI scan
- X-ray of your blood vessels (angiography)
If you have a family history of aneurysm or a genetic condition, your doctor may recommend genetic testing. Genetic counseling may provide information to help in family planning.
Thoracic Aortic Aneurysm Treatment at Penn
Penn’s team of cardiologists and cardiac surgeons helped pioneer thoracic aortic aneurysm treatments and continue to lead and advance the field. If your doctor confirms a thoracic aortic aneurysm, they will take measures to prevent it from growing and potentially tearing. Your doctor will use treatments including:
Active Surveillance
Sometimes called “watchful waiting,” your doctor routinely monitors the aneurysm using the same imaging tools used in diagnosis. How often you need imaging tests depends on the size of the aneurysm and how fast it is growing.
Medications
If you have high blood pressure or high cholesterol, your doctor may prescribe medicines to control them in order to prevent further weakening the artery wall.
Surgery
You may need surgery depending on the size of your aneurysm or your risk of a tear. Specialists at the Aortic Center will determine which surgery is appropriate. Surgical procedures may include:
- Thoracic endovascular aortic repair (TEVAR), where surgeons thread a synthetic reinforced graft (tube) to the damaged part of the aorta through a catheter inserted in an artery in your leg
- Hybrid aorta surgery, which combines open chest surgery with endovascular (catheter-based) surgery to treat complex aneurysms when one procedure isn’t enough
- Aorta surgery, open-chest surgery to repair the aneurysm by removing the damaged section and sewing a synthetic reinforced graft (tube) in its place
- Valve-sparing aortic root replacement, a specialized operation to repair the part of the aorta that connects to the heart without replacing the patient’s own valve
- Aortic valve surgery to repair or replace a damaged valve