What is a slightly tortuous aorta

Aortic root aneurysm: when does surgery make sense?

Status: 08.08.2016 14:50 | archive
Cross-section of a heart: the aortic arch can be seen in red above.

A pathological enlargement (aneurysm) of the main artery (aorta) directly on the heart means a double risk for the person concerned. On the one hand, there is a risk of the stretched vessel wall tearing or bursting, which would lead to bleeding to death within a few minutes. On the other hand, the aortic valve no longer closes properly due to the expansion. Blood flows constantly from the main artery back into the heart chamber, the patient suffers from what is known as aortic insufficiency and decreased performance.

Our main artery - the aorta

The aorta arises from the left ventricle and is shaped like a walking stick that runs down the spine until it divides into the two pelvic arteries in the lumbar region. The aortic arch is the handle of this walking stick. In healthy adults, the main artery has a diameter of 25 to 35 millimeters. It distributes the oxygen-rich blood from the heart throughout the body.

How does an aneurysm develop?

An aortic aneurysm usually develops from arteriosclerosis. High blood pressure, smoking and advanced age are the most important causes, but connective tissue diseases such as Marfan syndrome, Loeys-Dietz syndrome or Ehlers-Danlos syndrome can also contribute to the development of an aneurysm by weakening the vascular wall.

The aneurysm develops slowly and does not cause any discomfort for a long time. This is precisely what makes this disease particularly treacherous, because if the pathological enlargement is not discovered by chance during an ultrasound, CT or MRT examination, the patient is in fatal danger without even knowing it.

Ultrasound risk assessment

The doctor can estimate the risk of the vessel wall rupturing on the ultrasound image: the larger the diameter of the aneurysm, the higher the risk - regardless of whether the patient feels anything or not. If it is located at the aortic root, i.e. directly at the transition between the heart chamber and the aorta, an aneurysm can also impair the function of the heart valves. From a diameter of 40 millimeters, an aortic aneurysm should be checked once or twice a year.

Since the surgical procedure is not without risk, doctors only recommend preventive surgery if the aneurysm is already so large that the risk of bursting significantly exceeds the risk of surgery. This is usually the case with a diameter of more than 55 millimeters, with hereditary connective tissue diseases such as Marfan syndrome already at 45 to 50 millimeters. Even with rapidly growing aneurysms, surgery is often the lower risk.

Diameter (mm)rating
40Check every 6 to 12 months
45-50Surgery for certain comorbidities
from 55surgery

Complicated surgery with the heart-lung machine

The aortic aneurysm is a particular challenge for cardiac surgeons. In order for them to operate, the heart must be stopped. In this phase, the heart-lung machine takes over the work of the heart and lungs. Doctors have to work quickly and precisely, because if there is just one mistake or if the operation takes too long, the heart may never beat again. This notion is particularly stressful for patients who do not have any acute symptoms, but instead have to undergo a preventive operation.

In the complicated operation, the enlarged area of ​​the main artery is replaced with an implant, the aortic valve is repaired or replaced with an artificial valve. After the procedure, the patient has to rest for a while until everything has grown together again. Only then is the danger of suddenly bleeding to death inside you one day.

Cinematic view of the operating room

For the first time, an NDR team filmed a heart operation with a very special camera - using 360-degree technology. Internet users can navigate freely through the operating room in this film, take a close look at every detail of the complicated procedure and receive background information.

Interview partner in the studio:
Prof. Dr. Dr. Hermann Reichenspurner, cardiovascular surgeon
Director of the Clinic and Polyclinic for Cardiovascular Surgery
University Heart Center Hamburg GmbH (UHZ)
Martinistraße 52, 20246 Hamburg
Internet: www.uhz.de

Interview partner in the post:
Priv.-Doz. Dr. Evaldas Girdauskas, cardiac surgeon
Clinic and Polyclinic for Cardiovascular Surgery
University Heart Center Hamburg GmbH (UHZ)
Martinistraße 52, 20246 Hamburg
Internet: www.uhz.de

Additional Information:
German Heart Foundation V.
Vogtstrasse 50, 60322 Frankfurt
Tel. (069) 95 51 28-0, Fax (069) 95 51 28-313

Kerstin Bauer, Jürgen Ennker, Stefan Bauer:
"Life after the heart procedure"
134 p .; Springer (2010)
22.99 euros

Kerstin Bauer, Jürgen Ennker:
"Aortic Surgery: A Patient's Guide"
168 p .; Steinkopff (2008)
19.99 euros

This topic in the program:

Visit | 08/09/2016 | 8:15 pm