Thoracic Aortic Disease

What is Thoracic Aortic Disease?

The aorta is the main artery that sends blood away from the heart to the rest of the body. It is shaped like a candy cane and is typically as wide as a garden hose (2.5-3.5 cm). When blood is pumped by the heart, it first travels through the aorta. The thoracic aorta is the part of the aorta that is located in the chest. The most important parts of the thoracic aorta to know are: the aortic root, which is where the aortic valve opens and closes to let blood out of the heart, the ascending aorta, the arch, or curved top part of the candy cane, and the descending aorta. Thoracic Aortic Disease is an aneurysm, dissection, or rupture of any part of the aorta in the chest.

An aortic aneurysm is a balloon-like bulge in the aorta that can occur in the first part of the aorta and involve the root of the aorta or the ascending aorta, or both.

Aneurysms are a serious problem because they can tear or rupture if not properly diagnosed and clinical managed.

Most often aneurysms do not cause any symptoms. Imaging is the only way to identify an aneurysm.

normal aorta and an aorta with an anuerysm

As an aneurysm enlarges, it increases the risk for an acute aortic dissection.

The aorta is made up of three layers. An aortic dissection happens when the blood tears through the inner layer of the aorta, and then starts to flow in the thick middle layer of the aorta, leading to blood flowing through the true lumen and a false lumen formed by the blood entering the wall.

An aortic dissection is a medical emergency and can cause sudden death, but these deaths are preventable with early diagnosis and management.

normal aorta and an aorta showing a tear or dissection

What are the types of dissections?

Acute aortic dissections are classified by where the tear begins in the aorta and how far the dissection goes. The Stanford system classifies dissections as type A or type B. The DeBakey system classifies dissections as type I, type II, or type III.

Stanford type A type B, Debakey type I, type II, type III
https://www.youtube.com/watch?v=lXGEdX7Alxk lXGEdX7Alxk

Risk factors for developing thoracic aortic aneurysms and aortic dissections

Several factors can increase your risk to develop a thoracic aortic aneurysm or aortic dissection.

  • Family history of thoracic aortic aneurysm or thoracic aortic dissection
  • A genetic condition that increases risk of aortic disease
  • Uncontrolled hypertension (high blood pressure)
  • Stimulant or illicit drug use (methamphetamine or cocaine)
  • Bicuspid aortic valve
  • High intensity weightlifting (see IRAD for recommendations regarding lifestyle and work)
  • Trauma to the aorta (e.g. being in a car accident)

Depending on your specific condition other risk factors may apply.