Aortic Aneurysm/Dissection Diagnosis

Diagnosis of an aortic aneurysm before symptoms occur is ideal, but unfortunately, diagnosis often takes place only when symptoms arise. Because aneurysms may cause no symptoms until the aneurysm tears, many go undetected until they burst.

Of those aneurysms that are found before patients develop serious symptoms, most are detected incidentally in the process of conducting evaluations for other conditions. Most commonly, a routine physical exam may allow for the detection of a heart murmur. This finding will often prompt your doctor to perform an echocardiogram. This test will allow for accurate imaging of the aortic valve and the first portion of the aorta. Aneurysms may also be seen on a routine X-ray or a CT scan ordered for an unrelated purpose. Sometimes people may feel pain in the chest or back, so a chest x-ray or CT scan is performed. Alternatively, a person may have a scan following an accident or injury.

Diagnosing an Aortic Dissection

Detection of aortic dissection can be tricky because the same symptoms occur in conjunction with many other health problems. Aortic dissection is frequently misdiagnosed in the emergency room as a heart attack. Prompt diagnosis is essential, however: type A dissections are surgical emergencies, with a mortality rate of almost two percent per hour after onset.

Diagnosis can be made by CT scan of the chest and/or a transesophageal echocardiography (TEE, or ultrasound images of the heart taken from within the esophagus).

If a type A aortic dissection is strongly suspected, the patient is transported from our emergency room, or from an outside hospital, directly to the operating room for a confirmation of diagnosis via TEE. For those found to have a type A aortic dissection, surgical repair is performed immediately.

Valve Analysis

When a patient has an aneurysm of the aortic root, the aortic valve may also be damaged. Depending on how well the valve is functioning, it may need to be replaced or repaired when the aortic root aneurysm is repaired.

As has been shown previously with mitral valve replacement, the use of artificial valves is a lifesaving advance. Animal valves have a finite life span (approximately 15 years for most), and mechanical valves require life-long anticoagulation medication. or these reasons, repair is attempted whenever possible.

In the appropriate patient, preservation of the valve may provide longer symptom-free survival and reduced need for re-operation, as long as repairs can be achieved perfectly with no leakage. Thus the question of whether to repair or replace the aortic valve requires very careful consideration.

Our consideration of valve repair begins with examination of the valve on echocardiogram: is it normal? Does it leak? Are the leaflets stuck? Are there holes (fenestrations) in the leaflets? Are there two leaflets or three?

If the aortic valve appears normal, repair may be possible. We then carefully examine the valve at the time of surgery. Time is spent in evaluating the integrity of the leaflets, how they touch one another, and how they relate to the base of the heart. If, after this detailed analysis, we believe a repair is indicated, then we will perform a valve-sparing procedure. If the aortic valve is stenotic or calcified, we must determine whether the area of damage is restricted to one area, in which case it still may be rebuilt. However if the damage is widespread enough that it will require replacement, there is little value in performing an inadequate repair.