27 Diseases of the Aorta Flashcards
What are the normal aortic values?
2.0–3.1cm at the level of the aortic annulus.
2.4–4.0 cm at the level of the sinuses of Valsalva.
2.2–3.6 cm at the level of the sinotubular junction.
2.2–3.6 cm at the level of the ascending aorta.
<1.9cm/m2 at the level of the aortic arch.
<1.6cm/m2 at the level of the descending thoracic aorta.
<1.6cm/m2 at the level of the abdominal aorta.
What are the causes of aortic dilatation?
Atherosclerosis, hypertension, trauma, AS (post-AS aortic dilatation) and BAV.
Connective tissue diseases and inflammatory diseases include Marfan syndrome, systemic lupus erythematosus, rheumatoid arthritis, Reiter syndrome and syphilitic aortitis.
What are the echo characteristics associated with aortic dilatation?
BAV, AS, AR, atheroma, thrombus, dissection and coarctation.
How is the aortic root affected in Marfan syndrome?
There is effacement of the STJ (the boundary between the SoV, STJ and AA disappear).
What is a Sinus of Valsalva aneurysm and what are its causes?
A SoV aneurysm is the localised dilatation of one or more SoV.
SoV aneurysms can be congenital, secondary to an abnormality of the aortic media causing sinus dilatation. Normally, congenital cases affect one sinus.
SoV aneurysms can be acquired, secondary to atherosclerosis, endocarditis, cystic medial necrosis, trauma and syphilis. Normally, acquired cases affect one sinus.
SoV aneurysms can be associated with BAVs and VSDs.
What are the complications of a Sinus of Valsalva aneurysm?
AR, distortion of other structures (e.g. coronary arteries, RVOT, conduction system) and rupture into other structures (e.g. RV, RA).
What is an aortic dissection?
A tear in the intima of the aorta which allows blood to flow between the intimal layer and the medial layer. At the entry point, blood enters the false lumen and, at the exit point, the blood re-enters the true lumen.
How are aortic dissections classified?
Stanford: Type A involve the ascending aorta and type B do not.
DeBakey: Type I involve the ascending, arch and descending aorta, type II are confined to the ascending aorta, and type III are confined to the descending aorta.
What are the causes of aortic dissection?
Aortic dilatation or conditions which increase the strain on the aorta/affect wall strength (e.g. hypertension, pregnancy, Marfan syndrome, Ehlers–Danlos syndrome, BAV, aortic coarctation).
What are the associated characteristics and complications of aortic dissection?
Patients present with sudden-onset interscapular pain and a >20mmHg difference in BP between arms.
Aortic dissections can distort the AV, or cause AV prolapse, and cause AR, affect the coronary arteries and cause myocardial ischemia/infarction, and can rupture into the pericardial space and cause a haemorrhagic pericardial effusion and/or cardiac tamponade.
How are aortic dissections assessed?
TTE cannot rule out aortic dissection so TOE, CT or MRI may be required for diagnosis.
Use 2D to assess the dissection flap, a linear structure in the aorta which is mobile with erratic movement.
Use CFD to assess the true/false lumen. The true lumen is smaller and regular and shows systolic pulsatile expansion and systolic antegrade flow. The false lumen may show decreased or no flow, particularly if a thrombus is present.
What is an intramural haematoma and how is it shown on echo?
An intramural haematoma can present like an aortic dissection and can progress into an aortic dissection. In an intramural haematoma, blood flows from vessels supplying the aorta, not the aorta itself, into the haematoma.
On echo, an intramural haematoma appears as an echogenic circular or crescentic mass within the wall of the aorta, >5 mm thick, between the intima and adventitia.
What are aortic atheromas and how are aortic atheromas assessed?
An atherosclerotic plaque in the aorta.
On echo, it appears as irregular echogenic thickening of the intima of the aorta.
What are the complications of aortic atheromas?
Patients with aortic atheromas are normally asymptomatic but may present with CAD, causing angina and ischemia/infarction, cerebrovascular disease, causing TIAs and strokes, PVD, causing intermittent claudication.
Aortic atheromas can cause aortic dilatation and aortic dissection.
