What Is an Ascending Aortic Aneurysm?

Ascending aortic aneurysms are mostly young and middle-aged, often accompanied by aortic valve sinus and annulus enlargement. In severe cases, the aortic valve leaflets cannot be closed when the heart is dilated, showing aortic valve insufficiency. However, the aortic valve leaflet itself was not significantly affected. Some patients may show signs of Marfan syndrome, such as long head, high arch of the upper jaw, slender trunk, limbs, fingers, excessive extension of joints, malformation of chicken breast or funnel chest, and congenital dislocation of the eye.

Basic Information

nickname

Physical aneurysm

English name

aneurysm of ascendingaorta

Visiting department

Thoracic Surgery

Multiple groups

Young and middle-aged

Common causes

Atherosclerosis, trauma, infection, arterial necrosis, syphilis, congenital malformation

Common symptoms

Neck and upper limb veins are flared and enlarged

Causes of ascending aortic aneurysm

Most ascending aortic aneurysms are caused by cystic degeneration of the aortic wall. Other causes include atherosclerosis, syphilis aorticitis and chest trauma.

Ascending aortic aneurysm clinical manifestations

Ascending aortic aneurysms that have not invaded the aortic valve annulus can be asymptomatic at an early stage. When an aneurysm grows and oppresses the superior vena cava or innominate vein, the neck and upper extremity veins swell and expand. In advanced cases, the aneurysm grows forward to the chest wall and invades the sternum, causing severe pain, or even penetrating the chest wall, showing a pulsating mass. Aneurysm lesions cause aortic valve annulus enlargement, and those with aortic valve insufficiency will present with clinical symptoms of congestive heart failure. On physical examination, diastolic murmurs due to aortic valve insufficiency, pulse pressure widening, and water flushing can be detected. A chest radiograph revealed enlarged ascending aorta and left ventricle. Electrocardiograms often show left ventricular hypertrophy and strain. Aortic angiography showed ascending aorta and aortic valve sinus enlargement. Ascending aortic aneurysms caused by middle-layer cystic degeneration, most of the lesions are limited to the ascending aorta. From the beginning of the innominate artery, the outer diameter of the aorta is close to normal. In patients with aortic valve insufficiency, the contrast agent flows back into the left ventricle during diastole. According to the amount of contrast agent reflux, the severity of aortic valve insufficiency can still be determined.

Ascending aortic aneurysm

1. X-ray plain film inspection

Can show calcified tumor wall.

2. Arteriography

It is necessary to clarify the location, scope, size and other conditions of the aneurysm, which will help clear diagnosis and formulate a surgical plan.

3. Ultrasound

Can measure the size, pulsation and noise of aneurysms.

4. Reactive hyperemia test

Observe whether the collateral circulation of the affected limb is fully established.

Ascending Aortic Aneurysm Diagnosis

Thoracic aortic aneurysms are usually seen on chest radiographs. CT and MRI are particularly helpful in confirming their scope and size. Transthoracic ultrasound can accurately measure the size of ascending aortic aneurysms, but not the descending aorta. Transesophageal ultrasound can accurately measure both. Before the thoracic aortic aneurysm is ready to be removed, there are indications for contrast aortic angiography or magnetic resonance aortic angiography.

For syphilitic aneurysms, serum tests, especially the fluorescent Treponema pallidum antibody adsorption test and Treponema pallidum (Treponema pallidum) immune test, are mostly positive.

Ascending Aortic Aneurysm Treatment

After the diagnosis is clear, surgical treatment should be performed as soon as possible. In cases without aortic valve insufficiency, surgery should also be considered in order to prevent aneurysm rupture or concurrent dissection of the aneurysm. Ascending aortic aneurysms are mostly spindle aneurysms. The principle of treatment is to remove the ascending aorta of the diseased section and replace it with a vascular prosthesis or the same kind of aorta. Because the ascending aorta blood flow needs to be blocked during surgery, care should be taken to protect the heart, brain, spinal cord, and internal organs from damage caused by ischemia and hypoxia, and the left ventricle does not fail due to acute enlargement of blood flow. Ascending aortic aneurysms and aortic valve insufficiency often require removal of the aneurysm and aortic valve, and then perform aortic valve replacement and aneurysm resection and artificial blood vessel transplantation.

Ascending aortic aneurysm prognosis

The surgical mortality of ascending aortic aneurysms has been reduced to 5% to 10%. Syphilitic aorticitis is associated with higher early mortality in cases of aneurysms and dissecting aneurysms. In 90% of the surviving cases, symptoms disappeared or were significantly reduced, and cardiac function recovered to grade -.