What is aortic root dilatation?

Aortic root dilatation, as its name suggests, occurs when the aortic root is abnormally enlarged. It is also often referred to as aortic root aneurysm (from Greek ἀνεύρυσμα, aneurysma, “dilatation”, from ἀνευρύνειν, aneurynein, “to dilate”) and, when the aortic annulus dilates, aortic anulectasia. The causes can be very diverse, including chronic hypertension, infections and trauma. It is usually an asymptomatic condition until it is advanced, but due to its consequences it is considered a serious health problem that requires medical attention as soon as possible, usually on a priority or urgent basis.

Causes

The aorta is the largest artery in the human body and the root refers to the part considered to be the beginning of this blood vessel. That is, it is the outflow section of the aorta from the left ventricle of the heart, the area where the coronary arteries originate and which supports the aortic valve. This area is included in the ascending aorta, the section of the aorta anterior to the aortic arch and which is usually also involved in the aortic root aneurysm. Its expansion means that the vascular wall weakens and increases in diameter. The weakening together with the pressure from inside the vessel can cause the vascular wall to rupture, so it is considered a serious situation.

The normal diameter of the root and ascending aorta is usually between 2 and 3.5 cm and An aneurysm is considered existing when it exceeds 1.5 times the normal diameter. compared to the rest of the glass. Among the most common causes that lead to dilatation of the aortic root are:

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Degenerative causes: arteriosclerosis. Inflammatory processes: giant cell arteritis, Takayasu arteritis, tertiary syphilis, etc. Trauma. Infectious processes: those caused by fungi (mycotic aneurysm) stand out. Vascular wall defects: Usually associated with inherited diseases and disorders such as Marfan syndrome, Ehlers Danlos syndrome, or bicuspid aortic valve disease.

Risk factors that increase the chances of developing aneurysms include diabetes, alcoholism, smoking, cholesterol, advanced age and hypertension. These factors cause the aortic wall to lose elasticity and distension capacity, favoring its dilation.

Symptoms

Almost half of the patients are asymptomatic, therefore, the diagnosis of dilated aortic root is often incidental by listening to an aortic murmur or by chest radiography; later, it is usually confirmed by CT (Computed Axial Tomography), echocardiogram or magnetic resonance imaging, among other tests. When there are symptoms, the most common are:

Heart failure, derived from aortic valve insufficiency (dilation of the aortic ring prevents the valve from closing properly) chest pain Depending on the severity, it can be temporary, especially when performing physical exertion or postural changes. blows Symptoms derived from compression of other structures: superior vena cava, trachea, left bronchus, esophagus or recurrent laryngeal nerve Syncope. If syncope occurs, usually with loss of consciousness, this indicates that the aorta has ruptured (aortic dissection). This rupture causes internal bleeding that requires immediate medical attention.

Treatment

The normal course of a dilated aortic root is to continue to grow until it ruptures. o Aortic dissection or rupture has a mortality rate close to 100%. This explains the importance of early diagnosis and treatment. An aortic root diameter greater than 6 cm is associated with a 30% increased risk of rupture.

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There is pharmacological treatment, mainly aimed at improving the symptoms of heart failure, for patients who do not have the conditions to undergo surgery. For these patients, regular monitoring of the progression of the aneurysm and hygienic-dietary measures, such as not consuming alcohol, tobacco and controlling cholesterol levels are recommended.

o Replacement surgery is considered the main treatment. The diameter of the aneurysm is the main criterion for deciding when to intervene. In general, if the diameter is equal to or greater than 5 cm (50 mm), surgery is performed. In patients with Marfan syndrome or bicuspid aortic valve disease, surgery is usually performed if the aneurysm reaches a diameter of 4.5 cm (45 mm). Depending on the characteristics of the aneurysm, the entire aortic root, including the valve, or just part of it, is replaced. Sometimes the aortic arch can be part of the aneurysm and is also replaced in surgery. There are different techniques and replacement prostheses, depending on the case and the characteristics of the patient, the medical team will choose the most appropriate.

Gallery

Schematic of the aortic arch Aortic root dilatation seen on computed tomography angiography Scheme of replacement prosthesis in the aortic root and ascending aorta

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