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Common Congenital Heart Lesions - page 103 / 126





103 / 126

103 of 126

Aortic Aneurysms (AA)

Clinical Presentation: Often asymptomatic Patient may be aware of a pulsatile mass (especially if abdominal aorta is involved) Patient may have symptoms caused by compression of other structures by the aneurysmexamples:

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    Back pain (erosion of the vertebrae by large abdominal aneurysm)

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      Dysphagia/hemoptysis/respiratory problems (esophagus or trachea compressed by thoracic aneurysm)

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      Hoarseness (stretching of the left recurrent laryngeal due to aortic aneurysm)

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      Heart failure (aortic regurgitation from dilation of the aortic ring by aneurysm of the ascending thoracic aorta)

Physical Findings: Aneurysms of the abdominal aorta may be discovered by careful abdominal palpation – one would feel a large, pulsatile mass.

Aortic aneurysms most often seen incidentally on chest or abdominal x-rays, especially if the aneurysm’s walls are calcified.

Etiology and Pathogenesis: Atherosclerosis is implicated in approximately 90% of abdominal aortic aneurysms.

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    Atherosclerosis more common in descending aorta than ascending portion.

Atherosclerotic aneurysms rarely develop before age 50 and are more common in men

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    development is accelerated by smoking, hypertension, dyslipidemia (and other factors that predispose to

atherosclerosis in general)

Ascending aortic aneurysms are uncommonly atherosclerotic; instead they are related to cystic medial degeneration.

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    cystic medial degeneration (aka cystic medial necrosis) involves degeneration and fragmentation of elastic

fibers – w/ later accumulation of collagenous and mucoid material in the medial layer.

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    This condition affects ascending aorta due to greatest pulsatile expansions happening there

Medial degeneration can also happen with connective tissue disorders:

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    Marfan syndrome

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Medial degeneration can happen in response to hypertension and aging.

Pseudoaneurysm: may develop at sites of vessel injury caused by infection or trauma (puncture of vessel during surgery or percutaneous catheterization)

Vessel wall can also be weakened by the likes of: syphilis, TB, staph, strep, salmonella, inflammatory diseases, genetic defects of connective tissue fibers (approx 5-10% of patients have an affected first-degree relative)

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