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protectiNg
THE
largest
artery
A vigilant program at Westchester
Medical Center helps save the lives of
patients with thoracic aortic aneurysms
6
advances in
cardiovascular care
the aorta, shaped liKe a caNdy
c a n e, is t h e body’s largest blood
vessel.
It carries oxygenated blood
ve
and nutrients from the heart to the
rest of the system. Originating in the
heart’s left ventricle, the
a o r t a r is es a nd then
a rc h es b a c kward over
t h e l e f t lu ng, descends
t h ro u g hout the chest
i n to the abdomen, and
t h en ends by dividing
into the iliac arteries in
t h e pelvis.
In the average adult, the
aorta’s strong and fibrous walls
westchesterheartaNdvascular.com
must withstand the pressure of 10 pints
Heart & Vascular
of blood gushing through at all times.
colleagues,
An aortic aneurysm occurs when
cardiothoracic
the walls of the aorta weaken or balloon
surgeons Steven l.
out. Aortic aneurysms are called
lansman, M.D., Ph.D.,
thoracic if they occur in the chest above
and ramin Malekan,
the diaphragm and abdominal if they
M.D., consider
appear below.
each patient’s stature, family history
david spielvogel, m.d.
and other medical conditions as well
preveNtiNg disaster
as the aneurysm’s rate of growth and
Thoracic aortic aneurysms can develop
its diameter.
slowly or quickly. Two famous TV
Thoracic aortic aneurysms usually
comedians lost their lives to problems
do not make their presence known until
in the thoracic aorta: lucille Ball
disaster is imminent. But sometimes the
from a ruptured aorta following heart
condition is uncovered during a CT scan
surgery, and John ritter from an aortic
or other radiologic study for another
dissection.
medical issue.
At Westchester Medical Center,
If an aortic aneurysm is found and
Westchester Heart & Vascular’s
is within a safe size, the patient is placed
internationally recognized
on an individualized care schedule of
cardiothoracic surgeons have
ongoing exams and imaging studies.
implemented a comprehensive Aortic
If a patient has experienced an aortic
Aneurysm Program to prevent such
dissection and has had surgery to repair
tragedies by carefully screening all
it, he or she is immediately enrolled in
patients diagnosed with thoracic
the database because the patient is at
aortic aneurysms and managing their
risk to develop an aortic aneurysm.
care. The surgeons work closely with
ContinUEd on PAGE 8
ramin malekan, m.d.
steven l. lansman, m.d., ph.d.
“
Obviously
we prefer to treat
a thoracic aortic
aneurysm safely
and effectively
before it reaches
a dangerous
stage.
”
patients’ primary care physicians,
cardiologists and vascular surgeons to
WHEn An
track any changes in these aneurysms
anEURysm BURsts
through regular checkups, computed
tomography (CT) scans and/or
magnetic resonance imaging (MrI)
studies.
“Obviously we prefer to treat a
thoracic aortic aneurysm safely and
electively before it reaches a dangerous
stage,” says cardiothoracic surgeon
David Spielvogel, M.D., Director of the
Medical Center’s Aortic Aneurysm
Program.
moNitoriNg aortic aNeurysms
For many years, a thoracic aortic
aneurysm was considered safe until it
reached 5 centimeters in size. Today,
however, doctors at Westchester
Medical Center look beyond this simple
cutoff. To determine when to intervene,
an aortic aneurysm
that bursts is a medical
emergency, requiring
immediate attention. call
9-1-1 if you experience:
• sudden, intense,
persistent abdominal,
chest or back pain
• pain that radiates to
your back or legs
• sweatiness
• clammy skin
• dizziness
• loss of consciousness
• shortness of breath
• signs of stroke:
weakness on one side
of the body, difficulty
speaking, blurry vision
Dr. Spielvogel and his Westchester
to find A
physician
W E S TC H E S T E r M E D I C A l C E N T E r
1.877.wmc.docs (1.877.962.3627) | westchesterheartaNdvascular.com
ContinUEd fRoM PAGE 7
prote
protectiNg
THE
largest
larg artery
“Since 2006, when we began this
program at Westchester Medical Center,
Cardiovascular Surgery at Westchester
—developed by Dr. Spielvogel—is fast
Medical Center.
becoming the standard at heart centers
we have perfected our surveillance and
around the world.
our surgical techniques so that we have
wheN surgery is Necessary “We
achieved very successful outcomes
look for subtle changes to time elective
replaces the aortic arch with a Dacron
and very low mortality rates,” says Dr.
surgery, rather than risk having
graft. A separate graft containing three
Spielvogel, who is also a professor of
to repair the aorta in an emergency,” says
“limbs” is substituted for the area where
cardiothoracic surgery at New York
Dr. lansman, Chief of Cardiothoracic
three arteries branch off the arch.
Medical College, Director of Heart
Surgery at Westchester Medical Center
Transplantation, and Associate Chief of
and a professor of cardiothoracic surgery
in the descending aorta and the patient’s
at New York Medical College.
medical condition permits, the surgeon
The type of surgery used to
In this procedure, the surgeon
Sometimes when aneurysms are
may use an endovascular stent-graft
treat a thoracic aortic aneurysm
procedure, avoiding “open” surgery to
depends on the site of the weakness.
treat the aneurysm. Because there is no
The “gold standard” of surgery to
large chest incision, both pain and the
treat an aneurysm in the aortic root
risk of complications are reduced, and
and ascending aorta is the Bentall
there is a quicker recovery.
procedure, named for the English
surgeon who created it in the 1960s.
During a Bentall, the surgeon
The Westchester Heart & Vascular
cardiovascular surgery team also
performs complex surgical procedures
removes the area of the aorta containing
through incisions in the chest and
the aneurysm, replaces the aortic valve
abdomen to treat thoraco-abdominal
with a mechanical or bioprosthetic
aneurysms, which lie in both the chest
one, and then re-implants the coronary
and abdomen. Few heart centers have
arteries into a Dacron polyester tube
experience with such extensive aortic
KnoW YoUR
graft that replaces the section of
reconstructions.
anEURysm RIsK
ascending aorta that has been removed.
you’re at higher-than-average risk of aortic
aneurysm if you:
• are age 60 or older
• use tobacco
• have high blood pressure
• have atherosclerosis (buildup of plaque in
your arteries)
• are male (but women are at higher risk
for rupture)
• have a family history of the condition
• suffer chest trauma
• have a bicuspid aortic valve
• have marfan’s syndrome or ehlers-danlos
syndrome
Malekan use a technique called valve-
Preventing a stroke during aortic surgery
sparing aortic-root reconstruction for
is a challenge, as a stroke can occur
patients whose aortic valves are healthy.
as the result of tiny particles of debris,
Drs. Spielvogel, lansman and
“This saves a patient from a lifetime
of taking anticoagulant medications,
which are necessary to prevent blood
guardiNg BraiN aNd spiNal cord
called emboli, traveling to the brain and
blocking blood flow there.
At Westchester Medical Center,
clots from forming around a mechanical
special protocols protect the brain during
valve and putting the patient at risk for a
surgery. Methods include connecting the
stroke,” says Dr. Malekan.
heart-lung bypass machine to the axillary
artery, keeping blood flowing to the brain
advaNced procedures
while the heart is stopped, and cooling
If a patient requires repair of the aortic
the patient’s body temperature to slow
arch, a procedure called a trifurcated
the metabolism while stopping blood
graft technique will be used. This surgery
flow to vital areas.
.
8
advances in
cardiovascular care
westchesterheartaNdvascular.com