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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