Thoracic Aortic Dilatation
What is a dilated thoracic aorta?
The aorta is the major blood vessel that feeds blood to the body, and it runs from your heart through your chest and abdomen. An area of dilatation can develop anywhere along the aorta. Dilatations often grow slowly and usually without symptoms which make them difficult to detect. Many areas of dilatation start small and expand over time. How quickly the dilatation will progress is difficult to predict.
What can cause aortic dilatation?
- Family history – It is reported that 19% of people with an aortic aneurysm were found to have family history.
- Genetic disorders such as Marfan’s syndrome, Turner’s syndrome, Ehlers-Danlos syndrome and Loeys-Dietz syndrome can increase the risk of aortic dilatation.
- Degenerative diseases that cause breakdown of the tissue of the aortic wall.
- Atherosclerosis – Plaque build-up on the artery walls causes additional pressure which can cause the aorta to weaken and bulge.
- Aortic valve disease – Certain problems with the valve that blood flows through as it leaves the heart can lead to thoracic aorta dilatation.
- Infection – While rare, it is possible that an untreated infection can lead to an aortic aneurysm.
- Traumatic injury – While rare, traumatic injury can cause the development of aortic dilatation.
- Inflammation of the arteries
Can I prevent aortic dilatation?
Good blood pressure control (usually aiming for bp less than or equal to 120/80) and avoiding exercises which encourages breath-holding such as heavy weight lifting (general recommendation is to avoid lifting more than half your body weight), chin-ups, rowing etc are best avoided.
There is evidence to suggest that certain medications that slow down the heart, specifically, beta blockers (aiming for a heart rate of around 60 bpm) and blood pressure lowering medications such as losartan (called ARBs), can help reduce the progression of enlargement of the aorta. Treatment of infections such as syphilis and treatment of underlying auto-immune disorders such as lupus and rheumatoid arthritis will also help.
If you smoke, ask your doctor about finding a cessation program that will work for you.
If you do have an area of aortic dilatation, it is important to keep up with regular screening to assess its growth.
Treatment
We will assess your condition and discuss with you what your ideal treatment plan may be.
Treatment for thoracic aorta dilatation will depend on the cause, size and growth rate. If the area of dilatation is small, we may recommend a “watch and wait” approach with regular screening of the area to check on the size. Regular blood pressure checks may be required. If you smoke, it would be recommended that any smoking be ceased, if you are overweight it may be recommended that you lose weight, and if you are diabetic it is important to control your blood sugar.
Alternatively, if the dilatation is large enough or growing faster than usual, surgery may be recommended to avoid complications such as tearing of the aorta (or dissection), which can be fatal.
