British News Agency

"Aortic wall begins to thin."

Prof. Dr. Oğuş, who said, "The diameter of the outgoing aorta is on average 28-32 millimeters for those of average size and weight. When this diameter increases, and the aorta becomes excessively dilated, we call it an aneurysm," added:

"The aorta is an organ in our body responsible for carrying oxygenated blood to tissues through the blood pressure we call blood pressure. In order to resist this pressure, the aortic wall contains microscopic, neatly arranged, elastic, and strong connective tissue fibers. These fibers are broken down into molecules through some cellular and enzymatic activities on the one hand, and they are continuously renewed on the other hand. In some genetic connective tissue diseases, arteritis, and atherosclerosis diseases, the breakdown of these fibers continues, while the function of rebuilding is disrupted, and the aortic wall begins to thin. Normally, the aortic valve is tricuspid, but in some people, it is bicuspid from birth, which often accompanies aortic aneurysms. The valve itself usually does not cause problems until middle age. Sometimes symptoms like stenosis and/or insufficiency (the failure of the valve to close, allowing blood to flow back) occur. Complications occur when the thinned aortic wall ruptures outwardly (rupture) or when the layers that make up the aortic wall separate (dissection) and block the branches that go to the organs. Both can cause sudden loss of life."

"Can be detected incidentally."

Prof. Dr. Oğuş also pointed out that in other examinations conducted for another complaint, the diagnosis can be made incidentally. "For example, a computer tomography (CT) taken with suspicion of a lung infection can reveal that the aorta is dilated. Sometimes, a heart murmur caused by stenosis or insufficiency of the aortic valve can be heard, and when the patient is referred to cardiology, valve disease and an aneurysm can be diagnosed. After the diagnosis, aortic enlargement is monitored every 3-6 months with echocardiography or even better, CT. If the diameter of the aorta reaches or enlargements of more than 3 mm occur every 6 months, the patient is operated on before reaching the surgical threshold of 50 mm."

By the way, Prof. Dr. Oğuş reminded that in congenital connective tissue diseases such as Marfan, Ehlers-Danlos syndrome, and aneurysm of the aortic annulus, aneurysms of the aorta and other arteries can occur at a young age. "In such diseases, dissection and rupture can occur at a young age, so they are operated on before reaching the surgical limits," he said. 

"Can cause serious complications."

Prof. Dr. Oğuş emphasized that the asymptomatic progression of the disease is a risk factor: "An unnoticed aneurysm, if it does not rupture, can cause difficulty swallowing or breathing only when it reaches 7-8 centimeters and exerts pressure only on the surrounding organs. If there is an aneurysm in other parts of the aorta, for example, in the area of the next aortic arch, where the arteries to the arms and brain exit, it can cause breathing and swallowing difficulties earlier by putting pressure on the trachea and esophagus. In the abdominal cavity, discomfort with internal organs may occur, and the patient may feel the pulse in his abdomen or even notice the mass in his abdomen. Especially in a weak patient, the pulse above the mass can also be seen with the naked eye," he added.

"A very severe pain is usually felt in the area where it ruptures."

Prof. Dr. Oğuş continued, "The ruptured aorta is an organ located in the pericardium, which is next to the heart. When it ruptures, it can cause blood to flow into the pericardium and lead to death within minutes. In this section of the aorta where the blood vessels of the arm and brain are located, there are usually no tissues that can prevent bleeding or apply pressure from the outside, which is why aneurysms here are the most common complication and cause of death. Connective tissue diseases and bicuspid aortic valve diseases are generally considered the main causes in this area. The areas of the thoracic and abdominal aorta located further away each have relatively thick outer layers, but they can lead to sudden loss of life in case of rupture of the thoracic or abdominal cavity and blockage of the arteries. A rupture or dissection usually results in very severe pain, and if blood loss is significant, shock often occurs. Usually, more than 70% of patients do not survive the event. Those who survive usually die within 1-2 hours after the accident if not operated on in time. In this need for emergency surgery, both the risk of complications and the mortality rate increase significantly compared to surgeries performed in a timely manner," he said.

"Genetic characteristics play a major role in aneurysms that occur in young people."

He provided information about aortic aneurysms that occur in young years: "Genetic connective tissue diseases come first in aneurysms that occur in young years. Aneurysms associated with genetic connective tissue diseases, aortic aneurysms that occur after 30-35 years due to bicuspid aortic valves, and aneurysms that occur in older people are often due to aortic valve diseases or frequently atherosclerosis, known as atherosclerosis. In short, genetic characteristics come first in aneurysms at any age," he said. 

"Trauma can also lead to aortic ruptures."

Prof. Dr. Oğuş also pointed out that trauma can lead to aortic ruptures: "A sudden drop caused by falls from great heights or traffic accidents can also lead to aortic ruptures. If the accident victim reaches the hospital in time, there is a good chance of survival," he said. 

"Early action is an important factor in the success of the operation."

Prof. Dr. Oğuş emphasized that aortic aneurysm surgery requires very large and experienced procedures: "In operations performed before dissections or ruptures occur, we can achieve much more successful results. For these large procedures that pose serious life-threatening risks, experience is extremely important. In some cases, it is necessary to cool the body down to as low as 18 degrees and stop the entire blood circulation, and sometimes separate 'perfusion methods' need to be used to ensure the supply of blood to the brain and internal organs during the operation," he said.

He also provided information about advancing surgical techniques: "In the last 15-20 years, more and more aortic aneurysms in the chest and abdomen can be treated with the so-called Endovascular Aortic Repair (EVAR). Nowadays, classical operations that are only "a small part" for our patients are performed due to technological advancements and increasing experience. With the advancement of technology and the spread of experience, such large operations, which represent the highest in terms of the risk and application technique of heart surgery and can be tolerated by the human body, may soon become a thing of the past," he said. 

"Individuals with early death and heart attacks in the family... Pay attention to check-ups!"

Prof. Dr. Oğuş provided information on the measures and examination frequencies that are of utmost importance for each age group in this regard: "Every child should definitely be examined by a 'pediatrician' for heart and vascular diseases and monitored during growth. If an anomaly in the heart or vascular system is detected, it should be examined and monitored by a 'pediatric cardiologist' as needed. Although the age of 20-35 is a relatively safe period for heart and vascular diseases, it should not be forgotten that syndromes due to connective tissue abnormalities can also occur at this age. Such diseases can also occur in young people who have an eye disorder, joint and spinal deformities, long arms and legs, palate deformities, and especially excessively elastic joints, which are mainly noticeable in finger joints. Therefore, it is very important for these young people to be examined by a cardiologist. People without noticeable features in their family, even if they have no complaints and are considered "healthy history and family history," should have regular cardiological examinations and tests from the age of 45 for women and 40 for men. This will not only allow for the early detection of diseases such as atherosclerosis, which is the most common cause of death but also for the early detection of diseases such as aortic aneurysms, which progress silently and can cause sudden death. People who have "early and sudden death" in their family, even if there is no known reason, should always remember that they can potentially be heart patients at any time, and it is recommended to advance cardiological monitoring by 5 years." he said.