the aorta

Monday, December 19, 2011

Having to move to a new city and change jobs is difficult for most people but not as tough as it has become for NBA player, Jeff Green. After being traded from Oklahoma City to Boston, his career has come to grinding halt because a routine preseason physical exam found some not so routine results. An echocardigram or ultrasound of Mr. Green’s heart detected an aortic aneurysm or abnormal bulging of the main artery that leads from the heart to the rest of his body and surgery is scheduled. Without repair, the aorta can leak or rupture potentially causing sudden death.

Usually, aortic aneurysms are found in older people and are associated with hypertension or high blood pressure. The increased force of blood being pushed from the heart against the walls of the aorta combines with gradual breakdown of the protein and elastic fibers in the blood vessel wall to cause a weak spot.. When a portion of the aorta weakens, it can balloon out just like a tire wall can have a weak spot that balloons out. In younger patients, the mechanism is different and a couple of different risk factors are present. With Marfans Syndrome, a gene mutation can cause an abnormal protein in the building blocks that make up the aorta and lead to weakened walls. Another alternative cause is an abnormal aortic valve, the one way valve that allows every heart beat to squeeze blood from the heart into the aorta.

There are a variety of other causes as a result of infections and other inflammatory diseases but one thing is true for most situations, the aneurysm is silent in hiding until potential disaster strikes. Symptoms occur when either aneurysm starts to dissect or leak causing pain and potentially sudden death. In older people, the aneurysm is often found incidentally on a routine chest x-ray, where the aorta’s shadow is abnormally enlarged. The diagnosis is confirmed by echocardiogram or by CT or MRI angiography.

Depending upon the age of the patient, associated medical problems and the size and location of the aneurysm, surgery is often recommended to prevent the consequences (including death) of a ruptured aneurysm. While techniques and outcomes have improved dramatically in the past 20 years, there is still a small risk of major complications including stroke, heart attack and even death.

If Mr. Green returns to play pro basketball, he’ll join a couple other players with aortic aneurysms who recovered from surgery and were able to play again. The spectre of a player collapsing on the court with sudden death has led the NBA to require screening echocardiograms as part of the pre-participation physcial exam. Unfortunately, the test is expensive and requires the skill of a special trained cardiac ultrasonographer or physician cardiologist to gather the images and interpret them and that prevents it from being available for every high school athlete. Of course, it may be a matter of priorities since an echocardiogram costs about as much as an iPad, but perhaps one day there will be an app for that.

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