What is Aortic Root Disease?
Aortic root disease is a collective cardio vascular syndrome which involves the abnormality of aortic root like root thickening, increased stiffness, dilatation etc. In some cases valve thickening is also seen. Along with the aortic root dilation and other conditions mentioned above, other forms of aortic root disease include aortic cusp thickening and renunciation, sub-aortic bump and aortic mitral regurgitation, anomalous coronary artery and Marfan's syndrome. All these conditions are collectively known as aortic root disease.
The aortic root diseases account for maximum number of cardiovascular complexities and mortality all over the world. The chances of occurrence of aortic root disease increases as the age increases. The diagnostic evaluation of the aortic complications has increased up to many times in the last 20 years. This evolution has assured better and early diagnosis of the complication and improved therapeutic intervention.
Anatomy of Aorta
The aorta is the main artery which comes out of the heart and is the major reservoir of oxygenated blood that supplies to the whole body. Anatomically the aorta is divided into various portions: the thoracic aorta which consists of the aortic root; the ascending aorta (diameter about 3cm); the aortic arch and the descending thoracic aorta, with a diameter of about 2.5 cm.
The aorta is the main blood vessel which carries blood out of your heart. It is an outsized artery, elastic in nature, comprising three stratums: the Tunica Adventitia, Tunica Media and Tunica Interna or Intima. A single layer of endothelial cells make the Tunica Intima, the innermost layer of aorta. The middle layer is the thickest of all, and is made up multiple layers of smooth muscular cells, elastic tissue and collagen which provide elasticity and tensile strength to the aorta and other arteries too. The Tunica adventitia is the outermost layer which comprises of loose connective tissue. It also contains the Vasa Vasorum, a system which supplies blood to the walls of aorta itself.
Characteristics of Aortic Root Disease
The aortic root disease is characterized by the necrosis of the cells and tissues of the aortic wall. This degenerated form of tissue is weak and lacks sufficient elasticity to stretch and contract properly. The weakened area becomes dilated and when it reaches up to a certain size, it is referred to as ‘Aneurysm’. The term aneurysm is generally used when the axial diameter of the thoracic aorta becomes greater than 5 cm but when it measures about 4-5 cm the name ‘dilatation’ is used. The portion of the aorta becomes so weak that it can burst. The bursting may occur in rare cases and until it occurs the body does not shows any symptom or signs of the abnormality.
The aortic tissues may also tear due to necrosis even if the aortic root is not dilated. The slitting of inner layers of the walls causes leakage from the middle layer of the aorta causing separation of the inner and outer layers. This is termed as dissection
Treatment of Aortic Root Disease
The treatment of the aortic root diseases involves a complex surgical process depending on the type of abnormality i.e. dilatation or aortic aneurysm and the extent to which aortic root has been affected. The aortic root is located near the junction of aorta and the heart. The surgery is performed majorly to treat the dilatation or the aneurysm of the affected section of the aorta. The aim of the surgery is to prevent the aneurysm rupture, tearing of the inner layer of the dilated aorta i.e. aortic dissection and stretching of dilated aortic valve. The Aortic root disease may be associated with many other cardiovascular abnormalities like the Marfan’s Syndrome.
The most suitable treatment for aortic root diseases can be discussed with the surgeon and also the risks involved with the surgery.