Aortic Diseases
The aorta is the main artery that carries about 200 million liters of blood from the heart to the body over an average lifetime. The aorta begins with the heart valve and the portion up to the diaphragm is referred to as the thoracic aorta, and the part that travels into the abdomen after the diaphragm is called the abdominal aorta. In the damaged or weak aorta, the ballooning (aneurysm) or rupture of the layers (dissection) may be seen. Occasionally, aortic narrowing and complete blockage may occur. All this increases the risk of a life-threatening event.
Many Experts Should Be Together
Many specialists must work together in the diagnosis and treatment of aortic vein and valvular diseases, which are manifested in different ways and causes. These include cardiology, cardiovascular surgery, radiology, rheumatology, neurology and genetics specialists.The aim of the Liv Hospital Aortic Center is; cardiologist, cardiovascular surgeon and other experts to combine knowledge, experience and skills to select the most accurate diagnosis, treatment and treatment methods required for aortic diseases and to provide the most competent way to use.
Aortic Damage And Weakening Factors
- Atherosclerosis
- Medial degeneration
- Hypertension, smoking
- Genetic diseases (such as Marfan syndrome)
- Congenital disorders
- Connective tissue diseases, autoimmune and inflammatory diseases
Diseases that arise in aorta and require treatment
- Aortic aneurysms
- Aortic dissections
- Penetrating aortic ulcers
- Intramural hematoma
- Aortic coarctation
- Aortic stenosis and obstruction
- Aortic valve insufficiency
- Aortic valve stenosis
Aortic diseases often develop without complaint and occur suddenly with vital events. However, many complaints may be associated with different aortic diseases.
Complaints Related to Different Aortic Diseases
A sudden onset of deep or tear can be associated with chest or abdominal pain, aortic dissection or rupture.Cough, shortness of breath, difficulty in swallowing or pain can be seen in large thoracic aortic aneurysms.
Stroke, temporary stroke or pain in the feet may occur in aortic atherosclerosis or dissections.
Hoarseness may occur due to nerve compression in rapid progressive enlargements.
In the endovascular approach, the convalescence period is shorter.
Aneurysms, which are the most common pathology after atherosclerosis in aorta, are defined as the diameter of the aorta greater than 1.5 times normal.
Approximately 17% of the aneurysms are located in the thoracic region and 78% in the abdominal region. Approximately 70 percent of thoracic aneurysms remain undiagnosed. In case of rupture, the mortality rate is over 95%. Abdominal aortic aneurysms occur in approximately 6.9% of the population over 65 years of age and more in males.
The likelihood of rupture increases in proportion to the increase in diameter and is fatal in 60-70 percent. Approximately 70 percent of cases are found by accident when searching for other causes. The European Society of Cardiology (ESC) recommends screening for men over 65 years of age, women who are over 65 years old, and those who have abdominal aortic aneurysms in their siblings.
The treatment of aortic aneurysms and dissections can be done by surgery, endovascular stent (EVAR / TEVAR procedure - small incisions in the groin, insertion of an aneurysm into the vein, or a stent implantation of the aorta) or a combination (hybrid approach). In endovascular approach, the mortality rate, hospitalization and convalescence period are less.
How is the treatment done?
Degenerative aortic stenosis has been clinically more common with the increase in the elderly population. 5-7% of people over 65 years of age have middle-to-advanced aortic stenosis and the prevalence increases with age. Since there is no effective medical option, aortic valve replacement (AVR) with open heart surgery for decades is the standard treatment approach for aortic stenosis.Taking into account the natural course of the disease (usually no more than 3 years after the onset of the symptoms), it has been suggested to administer AVR immediately after 1968, even if minor symptoms occur. However, many studies, including the well-known EuroHeart Survey, have shown that in more than 1/3 of the patients, although they are suitable for surgery, surgery cannot be performed for many reasons (most common; advanced age and comorbid diseases) and remain untreated. Therefore, because of the mortality and morbidity of the surgery, less invasive treatments have been sought and with the technological developments, the TAVi method has emerged.
TAVI is currently approved for patients with aortic stenosis who are surgically moderate to high-risk or unable to undergo surgery. In fact, the ongoing PARTNER-3 study compares TAV with surgery for low-risk patients. TAVI is performed in the beating heart, unlike surgery, and cardio-pulmonary bypass is not required. If necessary, deep sedation can be performed without anesthesia. The patient's recovery and return to normal life are also faster.