THORACIC AORTIC ANEURYSM WITH STANFORD A DISSECTION

ANATOMY AND PHYSIOLOGY

AORTA
The largest-diameter artery in the body
Begins at the left ventricle of the heart extending upward into the chest forming an
arch and then downward to the abdomen where it branches into the iliac arteries
above the pelvis
It transports oxygen rich blood from the heart to the rest of the body through the
systemic circulation
The size of the aorta is directly proportionate to the patients height and weight
Its diameter may range from 3cm (more than an inch) to 1.2cm (half an inch) and
typically the largest in the aortic root and smallest in the abdominal aorta
The aorta is divided in seven sections, namely; the aortic valve, aortic root,
ascending aorta, aortic arch, descending thoracic aorta, abdominal aorta, and
thoracoabnominal aorta
Aortic valve
Located just below the first
branches of the aorta, the coronary
arteries
It is the most important valve of the
heart and the most commonly
replaced heart valve
The aortic valve usually has three
leaflets and commissures
(tricuspid) but may also have two
leaflets and commissures (bicuspid
aortic valve)
The patient with bicuspid aortic
valve have a much higher chance to
develop aneurysms and dissection
(splitting or separating of tissues) of the aortic root and the
ascending aorta.
Aortic root
attached to the heart
the major part of the aortic root is the
aortic valve which allows blood to
flow from the heart to the rest of the
body when it is open and prevents
blood from flowing backwards into
the heart when it is closed
the left and the right main coronary
arteries branch off of the aortic root to
provide the needed blood to the heart
aortic root is typically aneurismal in
in many patients with connective tissue disorder
ascending aorta
the segment between the sinotubular junction and the largest aortic
branch vessel; the innominate (brachiocephalic) artery


This is the only portion of the aorta that does not give any branch
vessels
The ascending aorta is the most anterior (toward the front of the
body) portion of the aorta. Therefore, the most common symptom
from the ascending aorta and the aortic root is chest pain. This
pain may be confused with chest pain associated with ischemic
heart disease (coronary artery disease)
aortic arch
The aortic arch is the portion of the aorta that is in the shape of an
arch and connects the ascending aorta with the descending aorta
The major arteries that stem from the arch are: the brachiocephalic
artery, the left carotid artery and the left subclavian artery
The brachiocephalic artery is responsible for carrying blood to the
right arm and the right side of the brain, the left carotid artery
provides the left side of the brain with blood and the left subclavian
artery carries blood to the left arm.
There are many anomalies of the aortic arch such as the bovine
arch, where there are only two branch vessels off the aortic arch
The operations involving the aortic arch usually require the body to
be cooled down using the heart-lung machine. This technique is
called hypothermic circulatory arrest. Alternatives are complex
hybrid operations that usually do not require heart-lung-machine
descending thoracic aorta
Runs from the aortic arch to the diaphragm which is the point of
separation between the chest cavity and the abdominal cavity
It provides blood to the muscles of the chest wall and the spinal
cord
abdominal aorta
Runs from the diaphragm and ends just above the pelvis where it
divides into the iliac arteries
There are five arteries that branch from the abdominal aorta: the
celiac artery, the superior mesenteric artery, the inferior mesenteric
artery, the renal arteries and the iliac arteries
The celiac artery provides blood to the stomach, liver and pancreas
the superior mesenteric artery supplies blood to the small intestine
the inferior mesenteric artery supplies blood to the large intestine
the renal arteries provide blood to the kidneys as well as the
muscles of the abdominal wall and the lower spinal cord
The end of the abdominal aorta branches into the iliac arteries
which supply blood to the legs and the organs in the pelvis
thoracoabnominal aorta
The segment starting past the last branch of the aortic arch and
ends with the abdominal aortic bifurcation into left and right
common iliac artery
Three layers of the aortic wall
Intima
Thinnest layer
a single layer of simple squamous endothelial cells glued by
a polysaccharideintercellular matrix,
surrounded by a thin layer of
subendothelial connective
tissue interlaced with a number of
circularly arranged elastic bands
Media
Thick, elastic middle layer
Circularly arranged elastic fiber,
connective tissue, polysaccharide
substances
May be rich in vascular smooth
muscle, which controls the caliber of the vessel.
Adventitia
Thin outer layer
entirely made of connective tissue
includes vessels (vasovasorum) supplying the aortic wall with
oxygenated blood

These layers allow the aorta to absorb the force of the blood as it is
pumped from the heart to the rest of the body. The tissues of the aortic
walls allow it to stretch under pressure. When the pressure passes, the
walls relax.



















References:
https://ufhealth.org/uf-health-aorta-center/aorta-anatomy
http://cedars-sinai.edu/Patients/Programs-and-Services/Heart-Institute/Centers-and-
Programs/Aortic-Program/Anatomy-of-the-Aorta-and-Heart.aspx
http://en.wikipedia.org/wiki/Blood_vessel