Think about the main blood vessel that starts in the middle of your chest, at the heart, and carries blood throughout your body. We call this the aorta. To be precise, the first part that comes out of the heart is called the ascending aorta. This is like the main water pipe of our body. Sometimes, one of the walls of this blood vessel becomes weak and starts to bulge like a balloon. In medicine, we call this condition an aneurysm. This can be serious, because if this bulge gets too big, it can burst. So today we're going to talk about how to surgically repair a bulge in the ascending aortic aneurysm.
Who needs this surgery?
Simply put, this surgery is necessary in two main situations.
1. As an emergency: If this aneurysm in your aorta suddenly bursts (ruptures) or tears through its walls (dissections), it is an emergency, life-saving surgery. This is a very dangerous situation.
2. As a planned surgery: After your doctor finds that you have an aneurysm, he or she will assess the risk of it bursting, and if the risk is high, he or she will recommend surgery before it bursts. The doctor will usually monitor the size of the aneurysm and how fast it is growing with scans (`CT` or `Heart MRI`) that are usually done once or twice a year.
In most cases, a slowly growing or very small aneurysm will not require treatment for some time. However, if it is growing rapidly or has reached a dangerous size, it is safest to remove it surgically before it bursts.
What is the best time to have surgery?
The decision about when to have surgery depends on several factors, including whether you have symptoms, the size of the aneurysm, and how quickly it is growing.
Symptoms that require emergency surgery
If you experience any of these symptoms, it could mean that your aneurysm is about to rupture. Go to a hospital's Emergency Department (ETU) immediately.
| Attention! These are emergency danger signs! | |
|---|---|
| Sharp chest or upper back pain | A feeling of severe pain as if something is tearing inside the body. |
| Difficulty breathing | Coughing, hoarseness, shortness of breath. |
| Other features | Dizziness , fainting, excessive sweating, nausea and vomiting, rapid heartbeat. |
Cases of elective surgery
Even if you are not experiencing symptoms, your doctor may recommend surgery in the following cases:
| Factor influencing the decision | Description |
|---|---|
| The size of the aneurysm |
|
| The speed of growth |
|
| Other factors | Factors such as your body size (someone with a smaller body may need surgery even if it is smaller) and whether you have had other heart surgery. |
How is the preparation before surgery?
You will be prepared for the surgery several weeks before it begins.
- Medical tests: Blood tests to check kidney function, CT or MRI scans to check the entire aorta, and coronary angiography to check other blood vessels in the heart.
- Talking to your doctor: You should tell your doctor about all the medications you take (including vitamins and traditional medicines), as well as any other medical conditions you have, such as high blood pressure and diabetes.
- Smoking: It is very important to stop smoking completely at least one month before the surgery.
The doctor will give you instructions, such as not drinking water after midnight on the day of surgery and only taking the prescribed medication in the morning.
How is the surgery done?
This is open heart surgery. It is done while you are fully anesthetized (put to sleep).
1. Incision: The surgeon makes a vertical incision down the middle of your chest.
2. Blood circulation: You will be connected to a heart-lung machine. This will provide your body with the blood and oxygen it needs during the surgery.
3. Repair: The weakened, swollen part of the aorta is removed and replaced with a tube (graft) made of synthetic material. This acts as the new blood vessel.
4. Closure: After the new tube is sutured and fixed, the chest incision is closed with stitches or staples.
This surgery usually takes about three to four hours, but the time can vary depending on what needs to be repaired.
What happens after the surgery?
After the surgery, you will be kept in the intensive care unit (ICU) for a few days and closely monitored. Then you will be transferred to a regular ward. The entire hospital stay can last between 4 and 10 days.
You can expect the following during your recovery:
- Giving painkillers.
- Inserting a catheter to drain urine.
- Using a machine to assist breathing (in the first few hours).
- Wearing special socks (compression socks) to prevent blood clots in the legs.
What are the risks and benefits?
The main advantage is that it prevents rupture, which can be fatal. The success rate of a planned surgery is very high (about 95%-98%). This means that this is the best chance of saving a life.
But remember, if an aneurysm bursts, the chances of saving your life are very low. So if your doctor recommends surgery, it means that the risk of surgery is lower than not having it.
As with any major surgery, there are risks. Complications such as excessive bleeding, infection, heart attack, stroke, and kidney failure can occur. However, the medical team does its best to minimize these risks.
How long does it take to recover?
It usually takes between 4 and 6 weeks to fully recover. For some, it can take up to several months. During this time, you will have to adhere to certain restrictions.
- Avoid driving: Until your doctor gives you permission (usually for at least 1-2 weeks).
- Avoid lifting weights: Do not lift weights over 5 kg (for 4-6 weeks).
- Bathing: Do not take a bath until the wound has healed. You can take a shower.
- Exercise: Avoid overly strenuous exercise.
To reduce pain when coughing or sneezing , place a pillow over the wound and compress it. Also, loss of appetite and extreme fatigue are normal in the first few weeks. Don't worry about it.
When to see a doctor
If you experience any of the following symptoms during your recovery, notify your doctor immediately.
| Problem | Features to look out for |
|---|---|
| Wound-related problems | The wound becomes red, swollen, painful, warm, oozing green/yellow pus, and the edges of the wound are separated. |
| Other serious symptoms | Chest pain or shortness of breath even at rest, swelling of the legs, fainting, fever, cough with blood or green/yellow phlegm, blood in the stool. |
Take-Home Message
- An ascending aorta aneurysm is a serious condition. Planned surgery before it ruptures can largely prevent life-threatening complications.
- If you experience symptoms such as sudden chest pain and difficulty breathing, it is an emergency. Go to a hospital's Emergency Department (ETU) immediately.
- It takes time to fully recover after surgery. It is very important to follow the doctor's instructions exactly.
- After recovery, maintaining a heart-healthy diet, avoiding smoking, and controlling conditions such as diabetes and high blood pressure are essential for future health.
- If you have any questions about this, don't be afraid to talk to your doctor.
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