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Cardiothoracic Surgery

Aortic diseases often require swift intervention

12/01/2007

The thoracic aorta, which supplies arterial blood to the body as it ascends from the aortic valve of the heart, arches across the thoracic cavity, and then descends to the abdomen, is susceptible to a number of diseases that can have profound implications. The most common of these disorders, aortic aneurysms and aortic dissection, can lead to life-threatening ruptures of the aorta.

Aortic aneurysm and aortic dissection

An aneurysm is a weak spot in the aorta wall that bulges outward. Aortic dissection occurs when damage to the inner wall of the aorta allows blood to get between tissue layers of the aortic wall. Under pulsatile pressure of the heart pumping blood, the dissection can spread, splitting apart tissue layers as it progresses along the aorta. An area of aortic dissection produces a weakness in the vessel that makes it susceptible to rupture.
Apart from the risk if ruptures, dissections and aneurysms can interfere with aortic valve function and cause leakage back into the heart, impairing the efficiency of circulation. They can also interfere with blood supply to the heart, brain, spinal cord and other vital structures.
About 20 percent of patients with bicuspid aortic valve disease – a malformation in which the valve consists of two leaflets instead of three – suffer a deficit of a protein that helps provide structural integrity to the aorta and enables it to withstand a lifetime of pulsatile pressure. This deficiency leads to a higher risk of aortic disease.

Surgical repair

Stent grafts are used to treat a variety of aortic conditions, including aneurysm and aortic dissection. These grafts can be collapsed to pass through the patient’s arteries on a catheter and then be deployed in the aorta. Access to the arterial circulation is usually through the femoral artery in the groin. If the femoral artery is unsuitable due to disease or other condition, surgeons make a small incision in the abdomen to reach the larger iliac artery. Surgeons can also access the ascending aorta and the aortic arch to perform surgery on the aorta or the aortic valve directly through a small incision that can usually be hidden in the upper chest below the patient’s breast.

UCLA cardiothoracic surgery team

Diagnosing aortic malformations prior to rupture or dissection is critically important. Modern imaging technologies at UCLA facilitate accurate diagnosis, permitting surgical repair before the patient reaches a crisis situation. Elective aorta repair greatly reduces risk to the patient and offers excellent results. Aortic surgery is often performed on an emergency basis and a tertiary care center like UCLA that specialized in transplantation and other complex, high-risk operations can offer treatment advantages. UCLA can assemble a skilled and experienced team any time they are needed to evaluate these difficult cases, determine the best course of treatment, and carry out the treatment rapidly and expertly. Because stroke risk is high during these operations, the team at UCLA monitors the patient’s neurological condition during surgery to help surgeons fine-tune the procedure to minimize intra-operative and postoperative neurological injury.

Participating physicians

UCLA has a team of cardiothoracic surgeons, vascular surgeons, interventional radiologists and cardiologists to treat complex conditions of the aorta in the least invasive way possible.

Richard Shemin, M.D.
Professor and Chief, Division of Cardiothoracic Surgery
Executive Vice Chairman, Department of Surgery
Co-Director UCLA Cardiovascular Center David Geffen School of Medicine at UCLA
rshemin@mednet.ucla.edu

Ramin Beygui, M.D.
Associate Professor of Cardiothoracic Surgery
Director, UCLA Aneurysm Program

Curtis Hunter, M.D.
Assistant Clinical Professor of Surgery
Director, Cardiothoracic Surgery UCLA Medical Center, Santa Monica


Patient referral

For more information, or to refer a patient for evaluation or treatment, please call (310) 206-8232 or fax (310) 825-7473.





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