Aneurysm is the name given to the bubbling of an artery or a region of the wall of the heart by losing its elasticity. As a result of high blood pressure, the artery or heart wall, whose vascular wall structure is weakened, expands outward and appears as a bubble when viewed from the outside. If this bubbling tissue is stretched too much due to pressure, the aneurysm sac ruptures and life-threatening bleeding occurs.
Heart aneurysms often occur after a heart attack. It usually occurs in the left ventricle, where blood pressure is highest and heart attack is most common. When a heart attack develops in any part of the heart, the muscle tissue in this region loses its vitality. In the area that has lost its vitality, the muscle tissue gets thinner and weakens over time, leaving its place to fibrous tissue (scar-healing tissue) that does not have the ability to contract. Aneurysm may develop in this region depending on the pressure over time. Since this region does not have a contractile feature, heart failure may develop depending on the size of the area where the aneurysm develops. Rhythm disturbance is another possible problem. Since the inner surface of the aneurysm loses its normal heart tissue feature, it paves the way for blood clot formation. For this reason, there may be a clot in the aneurysm sac, and pieces of this clot may break off and occlude various arteries (such as the brain, arm, leg, foot). The most common place is the aorta, which is our main artery. These aneurysms are called aortic aneurysms. It may give different findings according to different segments of the aorta. Aneurysms that develop in the chest region of the aorta are generally called thoracic aortic aneurysms (TAA), and aneurysms of the aorta in the abdomen are called abdominal aortic aneurysms (AAA). These aneurysms usually develop in the aorta lower than the renal arteries.
Cerebral aneurysms are aneurysms of the arteries supplying the brain. Rupture of these aneurysms can cause cerebral hemorrhage, stroke and death.
Tissues forming the vessel wall, congenital diseases (such as Marfan disease, Ehler Danlos syndrome), infection, long-term uncontrolled hypertension, smoking and atherosclerosis are the basis for the development of aneurysms. are the main contributing factors. In many patients, aneurysm, hypertension and ather It is associated with cardiovascular diseases such as sclerosis. Since the inner surface of the vessel loses its normal vascular tissue characteristic, a clot forms in the aneurysm sac. Pieces of this clot may break off and occlude vital organs and the arteries that feed our legs and arms.
Symptoms
Symptoms may differ depending on the type, location and size of the aneurysm. Symptoms usually occur with the pressure of the aneurysm sac on the adjacent organs, nerves and other vessels.
Types of Aneurysms by Localization
Parts of the Aorta
Ascending aorta refers to the part of the aorta from the heart to the part called the arcus. This section also includes the aortic valve, where the aorta exits from the heart. The aortic arch, on the other hand, runs down the back in the chest cavity after giving 3 separate vessels to the brain and arms. The part between the thoracic cavity and the abdominal cavity up to the diaphragm is called the thoracic aorta. From the diaphragm, it enters the abdominal cavity and is called the abdominal aorta. Branches that feed the abdominal viscera emerge from the abdominal aorta. The abdominal aorta divides into two approximately at the level of the navel and ends by giving off the pelvis (lower abdomen) region and the branches that feed both legs. Aneurysms may develop in each, a few, or all of these different regions. Aneurysms are named according to the aortic region they contain.
Ascending (Ascending) Aortic Aneurysm
This type of aneurysm is usually found in examinations for aortic valve insufficiency. The aneurysm may spread up to the aortic arch, or even involve the entire arch. General symptoms are hoarseness, dry cough, chest pain and shortness of breath. When the aneurysm reaches a certain size, it is necessary to intervene to prevent spontaneous ruptures. Today, the most common method is the complete removal of the aneurysm sac and suturing an artificial graft (usually dacron graft) to the intact area.
Surgical Treatment
Surgical treatment of ascending aortic aneurysms depends on the extent of the aneurysm. includes different strategies. If aortic valve insufficiency is present, k It is also necessary to replace or repair the cover. If the aneurysm spreads to the aortic arch, this part should be replaced with a graft and the vessels going to the brain and arms should be anastomosed to this graft. During this procedure, with the help of a heart-lung machine, the patient is usually cooled to 18 °C, and the patient's entire blood circulation is stopped for a certain period of time. After surgery, you stay in the intensive care unit for at least 2 days. During this period, all your vital functions are expected to be fully fulfilled. This period may vary according to your postoperative course. Then, you will be taken to your room in the service and sent home with the necessary suggestions to continue your rest after an average of one week.
Thoracal (Descending/Descending) Aortic Aneurysm
Nurturing the left arm After giving the vein (left subclavian artery), the aorta runs downward in the thoracic cavity. Aneurysms involving this section are called thoracic aortic aneurysms. The most common complaint of patients is back pain. Pain may be felt in the left shoulder, chest, or between both scapulae. Patients usually have uncontrolled hypertension. When the size of the aneurysm reaches a certain diameter, it must be intervened to prevent sudden ruptures and bleeding.
Surgical Treatment
Surgical treatment of thoracic aortic aneurysms also requires different strategies depending on the extent of the aneurysm. includes. Sometimes it may be necessary to use a heart-lung machine. In this case, this system is used to reduce the stress of the heart and to circulate the vital organs in the abdomen, without stopping the heart. The aneurysm sac is completely removed and an artificial graft (usually dacron graft) is sutured to the intact area. If there are main vessels feeding the spinal cord and vessels feeding the intra-abdominal organs in the removed area, these vessels are also sutured to the graft. Since this region of the aorta also feeds the spinal cord, the most feared complication in this type of surgery is partial paralysis after surgery. Therefore, the intensive care process after surgery is also very important. After surgery, you stay in the intensive care unit for at least 2 days. During this period, all your vital functions are expected to be fully fulfilled. This period may vary depending on your postoperative course and possible complications. Then you will be taken to your room in the service After an average of one week, you will be sent home with the necessary recommendations to continue your rest.
Abdominal Aortic Aneurysm (AAA)
It is an aneurysmatic enlargement of the aorta running in the abdomen. It is usually seen after the exit of the renal arteries feeding both kidneys. It rarely includes the renal arteries and the arteries supplying the intra-abdominal organs. Back pain caused by the compression of the aneurysm on the surrounding spine and surrounding tissues is one of the most common complaints. The most typical finding is a pulsating mass (feeling a heartbeat) in the abdomen of thin patients. When the size of the aneurysm reaches a certain diameter, it must be intervened to prevent sudden ruptures.
Surgical Treatment
Artificial graft (usually dacron graft) to the intact area by removing the aneurysm sac completely is planted. If the aneurysm includes the pelvic (lower abdomen) organs and the iliac arteries feeding both legs, repair is performed with leg grafts called trouser grafts. In this case, the ends of the legs of the graft are sutured to the femoral arteries in the inguinal region. After the surgery, you stay in the intensive care unit for 1 day. If you do not have any problems, you will be taken to your room in the service and sent to your home within 5-7 days on average, with the necessary suggestions to continue your rest.
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