Context

• The American football writer Grant Wahl died after a catastrophic tear in a major blood vessel leading out of his heart. The autopsy found that Wahl had an “ascending thoracic aortic aneurysm”, a weakening of the blood vessel that often goes undetected.

About Thoracic Aortic Aneurysm

• As the aneurysm grows, it may produce a cough, shortness of breath or chest pain as a result of which the vessel may widen to more than 50 per cent of its usual diameter. Aneurysms are more commonly seen in arteries than in veins.

  

• The aorta is the main artery that carries oxygenated blood from the heart to the rest of the body; it is also the body’s largest blood vessel.
• An aortic aneurysm is a weakening and bulging in a portion of the aorta; “thoracic” refers to that section of the blood vessel that passes through the chest.
• Aneurysms occur more often in the portion of the aorta that runs through the abdomen rather than the chest (causing what is called “abdominal aortic aneurysm”).
• An aneurysm increases in size over time, and the wall of the blood vessel gets progressively weaker in that area.
• The vessel may ultimately burst or separate, triggering a bleeding rush that can be life-threatening, and potentially lethal.

Causes and symptoms

• Among the possible causes of thoracic aortic aneurysm
  • (i) degenerative disease that causes breakdown of the aortic wall tissue;
  • (ii) genetic disorders;
  • (iii) family history;
  • (iv) vasculitis, or inflammation of the arteries; and
  • (v) atherosclerosis, or the build-up of plaque on the walls of the artery.
• In rare cases, an infection can also trigger an aneurysm.
• Symptoms of thoracic aortic aneurysms may depend on the location, size and speed of growth of the bulging; often, there are no symptoms at all.
• Symptoms, if they appear, may include (i) pain in the jaw, neck, chest, or upper back; (ii) wheezing, coughing, or shortness of breath (due to pressure on the trachea); (iii) hoarseness (due to pressure on the vocal cords); and (iv) trouble swallowing due to pressure on the oesophagus. These symptoms are not unique to thoracic aortic aneurysms, which may delay focussed medical attention.

Diagnosis and treatment

• A doctor may look at the patient’s medical history and carry out a detailed physical examination, including a computed tomography (CT) scan, magnetic resonance imaging (MRI), an echocardiogram (Echo), a transoesophageal echocardiogram (TEE), a chest X-ray, and an arteriogram (angiogram).
• Treatment may include monitoring the size and rate of growth of the bulge through an MRI or CT, and managing risk factors such as quitting smoking, controlling blood sugar (for diabetics), losing weight (if overweight), and eating healthy. Medicines may be prescribed for high cholesterol or high blood pressure.
• Surgical intervention may be needed if the aneurysm is large or is causing symptoms, and may include thoracic aortic aneurysm open repair (making a large incision) or endovascular aneurysm repair (EVAR), which requires small incisions in the groin. The surgery could remove the aneurysm, or insert a stent to support the blood vessel against possible rupture.

About Marfan syndrome

• Marfan syndrome describes it as a genetic condition that affects connective tissue and can damage the blood vessels and cause aneurysms of the aorta.
• The syndrome presents in around 1 in 5,000 individuals and is caused by a mutation in the FBN1 gene that limits the body’s ability to make the proteins needed to build connective tissue, according to the CDC.

Source: IE

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