Aortic Disease - Pathology, Presentation, Investigation and Therapy

Question 1

Describe the structure, course and layers of the thoracic aorta

Answer 1

4 SECTIONS
- aortic root
- ascending thoracic aorta
- aortic arch
- descending thoracic arch

3 SINUSES
- right sinus of Valsalva
- left sinus of Valsalva
- Non-coronary Valsalva

3 LAYERS
- Tunica intima
- Tunica media
- Tunica adventitia

Question 2

Define pathophysiology of aneurysm

Answer 2

TRUE
- weakness and dilation of wall
- involves all 3 layers

FALSE
- rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue

Question 3

Define pathophysiology of aortic dissection

Answer 3

• Tear in the inner wall of the aorta
• Blood forces wall apart
• Acute - medical/surgical emergency
• Chronic

Question 4

Define the clinical presentation of acute thoracic aneurysm

Answer 4

ASYMPTOMATIC

BASED ON LOCATION OF THE ANEURYSM
- shortness of breath
- dysphagia and hoarseness
- back pain
- symptom of dissection
- pulsatile mass

Question 5

Define the clinical presentation of acute aortic dissection

Answer 5

• Chest pain (severe, sharp, radiating to back)
• Collapse (tamponade, acute AR, external rupture)
• Stroke (involvement of carotid arteries)

Question 6

Understand the clinical changes to pulse findings in coarctation of the aorta

Question 7

Define Marfan’s syndrome and understand the possible aortic manifestations

Answer 7

Caused by Fibrillin 1 gene
Causes connective tissue weakness

AORTIC MANIFESTATIONS
- Aortic/Mitral valve prolapse and regurgitation
- Aortic thoracic aneurysm and dissection

Question 8

Define the broad classification of aortic aneurysm BY SITE

Answer 8

• ascending aorta aneurysm
• aortic arch aneurysm
• descending aorta aneurysm
• abdominal aorta aneurysm

Question 9

Define the broad classification system of aortic dissection

Answer 9

TYPE A
- involves ascending aorta

TYPE B
- Any other dissection that does not involve the ascending aorta