An aortic root aneurysm is a bulge or weakened area that occurs at the beginning, or root, of your aorta — your body's largest blood vessel. Aortic root aneurysms often have no symptoms. Doctors find them during x-rays or CT scans to diagnose other conditions.
At UPMC, we offer complete cardiovascular care. We use a team approach to tailor treatment plans for complex conditions, including aortic root aneurysms.
On this page:
What Is an Aortic Root Aneurysm?
The aorta is the body's largest blood vessel. It transports blood to the body from the heart.
An aneurysm occurs when a blood vessel stretches or bulges in one place. An aortic root aneurysm occurs in the beginning, or root, of your aorta.
Doctors also call an aortic root aneurysm a dilated aortic root.
How common is aortic root aneurysm?
Aortic root aneurysm affects between 5-10 people out of 100,000 in the U.S.
What causes aortic root aneurysm?
Aortic aneurysms occur because of molecular and connective tissue changes in the wall of the aorta. These changes sometimes cause the aorta to narrow or become blocked due to conditions like atherosclerosis, which causes plaque to build up inside the arteries. This can cause a breakdown of the muscular layer in the aorta, resulting in aneurysms.
Aortic root aneurysm risk factors
Certain health problems increase the risk for aortic root aneurysms, including genetic or connective tissue disorders such as:
- Marfan syndrome – Marfan syndrome affects your body's connective tissue and may cause problems with your heart valves or weaken your aorta.
- Ehlers-Danlos syndrome (EDS) – EDS is a group of genetic disorders that affect the connective tissue, including your blood vessel walls.
- Loeys-Dietz syndrome (LDS) – LDS is a genetic disorder that can cause aortic aneurysms or dissections.
Autoimmune or inflammatory diseases that affect the arteries also raise your risk. These include:
- Kawasaki disease – Kawasaki disease causes inflammation in the walls of your blood vessels.
- Takayasu arteritis – Takayasu’s arteritis is a rare form of vasculitis that can cause inflammation and damage to the aorta.
- Behcet's disease – Behcet’s disease causes inflammation throughout the body, including in the blood vessels.
- Giant cell arteritis – Giant cell arteritis is an inflammatory condition that causes narrowing or blockage of the aorta and other blood vessels.
Other health and lifestyle factors that increase aortic root aneurysm risk are:
- Infections around the heart.
- High blood pressure.
- Atherosclerosis (hardening of the arteries).
- Smoking.
Aortic root aneurysms can also result from birth defects of the heart or blunt trauma (an extreme blow) to the chest.
Complications of aortic root aneurysm
The aortic root has a valve that allows blood to pass from the heart to the aorta.
When the heart pumps blood out, the valve opens. The valve then closes to prevent blood from flowing back in from the aorta.
When an aneurysm stretches the aorta, the valve can't fully close. Because the valve stays open, the blood pumped into the aorta can flow back into the heart.
This causes problems such as:
- The coronary arteries, which supply blood to the heart muscle, don't get enough blood from the aorta.
- The rest of the body's organs don't get enough blood.
- The aneurysm can dissect, which means the layers of the blood vessel can start to tear.
- The aneurysm can rupture, which means it can burst open and leak blood quickly into the body. This is a life-threatening condition with a low chance of survival.
- Blood clots can form near the aneurysm and travel to other parts of the body, including the brain, lungs, and heart.
How can I prevent aortic root aneurysm?
Though some people are at higher risk for this disease, it doesn't mean they'll form an aortic root aneurysm. If you're at higher risk for an aortic root aneurysm, ways to help prevent it include:
- Making healthy lifestyle choices.
- Eating heart-healthy foods.
- Quitting smoking.
If you received an aortic root aneurysm diagnosis, you should:
- Have a heart doctor routinely check your condition.
- Track your blood pressure and share your results with your heart doctor. Strict blood pressure control is vital for treating aortic root aneurysms.
- Ask your doctor if you can exercise, and how much. A dilated aortic root doesn't rule out exercise, but your doctor can advise you on what types are best for you.
What Are the Signs and Symptoms of Aortic Root Aneurysm?
Aortic root aneurysms often have no symptoms. Some possible aneurysm symptoms are:
- Dull chest pain.
- Chest pain during exercise.
- Shortness of breath.
If the aneurysm dissects or ruptures, symptoms include:
- Sharp chest pain, sometimes also felt in the back.
- Extreme shortness of breath.
- Trouble swallowing.
- Fainting/loss of consciousness.
When should I see a doctor about my aortic root aneurysm symptoms?
If you have symptoms of an aortic root aneurysm, schedule an appointment with your doctor right away. Early diagnosis and treatment can reduce your risk of a life-threatening aortic rupture.
An aortic dissection or rupture is a medical emergency. If you experience symptoms or aortic dissection or rupture, dial 911.
How Do You Treat Aortic Root Aneurysm?
Your doctor will recommend a treatment plan based on the size of your aneurysm and any other health issues you may have.
The aortic root dilation, or bulge, may grow larger. It will not shrink on its own. Treatment recommendations may include:
Monitoring
If the aneurysm is small and not causing any problems, your doctor may suggest waiting to see if the aneurysm is growing.
When does an aortic root aneurysm need surgery?
If your aneurysm is 50 percent larger than the rest of the artery, you may need surgery. Doctors mainly suggest surgery when an aortic root dilation reaches five centimeters.
Surgery to treat aortic root aneurysm
Doctors can provide surgical treatment for aortic root aneurysm by:
- Rebuilding your aortic root and any damaged aortic valves.
- Using grafts in the vessel.
An aortic root replacement procedure replaces a section of the aorta with an artificial tube, or graft. The aortic valve is also removed and replaced with a mechanical or biological valve.
Open aneurysm repair surgery
During open aortic root aneurysm repair, your surgeon will:
- Make an incision in your chest.
- Replace the weakened portion of your aorta with a fabric tube called a graft.
- Repair or bypass vessels if the aneurysm involves important branches of the aorta.
After surgery, you will stay in the hospital for 5-7 days. Most patients make a complete recovery in 2-3 months, depending on the complexity of your surgery, your overall health, and whether you have other conditions such as heart, lung, or kidney disease.
Endovascular aneurysm repair
Your surgeon may recommend repairing your aortic root aneurysm with a minimally invasive EVAR procedure. Whether or not you can have an EVAR procedure depends on the shape, location, and extent of the aneurysm.
In contrast to a traditional “open" surgery, no big incisions are made in the chest. Instead, the arteries in the groin are accessed either by a needle puncture or a small incision.
During EVAR, your doctor will:
- Insert a small, thin tube called a catheter through a small incision into a blood vessel in your groin.
- Use the catheter to guide a small metal and fabric tube called a stent through your blood vessels to the aneurysm.
- Expand the stent to hold the weakened portion of the aorta open, redirecting blood flow through the stent to relieve pressure on the bulging aorta.
After an EVAR, most people recover quickly and can often go home the next day. However, yearly follow-ups with your surgeon are required because the stent can shift over time.
EVAR reduces your hospital stay by 2-3 days and requires less recovery time when compared to traditional open thoracic aortic aneurysm repair.
If EVAR is not an option for you, you may have access to other minimally invasive treatment options. UPMC routinely participates in clinical trials of leading-edge devices to treat complex aortic aneurysms.
How effective is treatment?
Many open aneurysm repairs are successful in the long term with few complications. Follow-up after open aneurysm repair is less frequent than that for EVAR, with most patients coming back every 2-3 years for a checkup.
However, EVAR requires more frequent follow-up visits and imaging studies to ensure that the graft continues to function properly. You also may require periodic maintenance procedures.
What is the life expectancy of someone with an aortic aneurysm?
Your life expectancy depends on whether you receive early, effective treatment, the size and extent of your aneurysm, and whether your aneurysm has ruptured. Your doctor will discuss your life expectancy with you.
