To many, having to undergo heart surgery will conjure images of an intrusive approach involving splitting the breastbone. However, whilst a traditional sternotomy is still performed in this way, advancements in medical technology have meant it isn’t the only option. Here at The Keyhole Heart Clinic, we specialise in minimally invasive heart surgery that provides quicker healing and recovery whilst leaving much less visible scarring for the patient. Keyhole surgery has opened many doors to providing those who require heart surgery with an alternative option, recognising that not all heart conditions require an intrusive approach. One situation that benefits from this is the approach to the treatment of dilated aortic root aneurysm associated with bicuspid aortic valve disease. This article describes what dilated aortic root means for you if you have been given this. We will also describe what a bicuspid aortic valve is, and why it is so important.
What is a Dilated Aortic Root & Why Is It Important?
Otherwise known as an aortic root aneurysm, a dilated aortic root is when the first section of the aorta, where the aortic valve resides, becomes enlarged. When this enlargement reaches a critical size, there is a risk of it rupturing or tearing, leading to a life-threatening situation. Aortic aneurysms that occur near the root can be related to Marfan’s syndrome as well as other congenital heart conditions such as the presence of congenital bicuspid aortic valve anatomy, and the risks of suffering from complications associated with a dilated aortic root can be heightened by smoking, any infections someone has had in the past around the heart, high blood pressure and atherosclerosis where the arteries become hardened.
When the aortic root becomes dilated, this can mean the valve cannot fully close and the blood that flows out of the heart to the body can flow back into the heart as a result of aortic valve regurgitation. The aortic valve has a vital role in helping with healthy blood circulation, meaning the risks associated with it developing problems can be life-threatening. Along with the Tricuspid, Pulmonary and Mitral valves, the Aortic valve needs to work consistently with the others so that blood, oxygen, and nutrients reach all parts of the body successfully. Separating the left ventricle from the aorta, if the aortic valve is not fully formed and not flexible enough to open and close efficiently, complications and symptoms become noticeable and potentially severe.
Aortic Root Dilation Symptoms & Complications
Unfortunately, many of those who develop an aneurysm may not suffer any aortic root dilation symptoms. This can mean that in many cases the diagnosis is made accidentally perhaps during a regular heart screening. We recommend that all adults with a family history of aortic root dilatation, or bicuspid aortic valve (image credit Medical Graphics), receive screening to ensure that they have not had this condition passed onto them in their genes.
The symptoms associated with aortic root aneurysms are often non-existent but can include dull chest pain, shortness of breath and chest pain whilst exercising. If the dilated aortic root ruptures, this can cause more severe aortic root dilation symptoms including sharp chest pain as well as in the back, more severe shortness of breath, fainting or issues with swallowing. This should never be allowed to happen in the modern day as surgical treatment can avoid this situation.
If the aortic valve does not close properly, then the aortic valve regurgitation can produce symptoms of shortness of breath, palpitations, and ankle swelling.
Keyhole Surgery Approach to the Dilated Aortic Root
Depending on how large the aortic root aneurysm has become, and the severity of any symptoms associated with the presence of aortic valve regurgitation, surgery will be required as the aneurysm, once dilated, will not reduce on its own. The traditional treatment is called aortic root and aortic valve replacement through a full breastbone incision. At The Keyhole Essex Heart Clinic, we prefer to always consider aortic valve repair and aortic valve sparing aortic root replacement through a keyhole incision as this gives us the opportunity to offer our patients quicker recovery and longer aortic valve durability. However, fewer than 1% of aortic valve surgeries worldwide are performed this way according to research. Due to the number of heart surgeons and cardiologists that have the necessary skill set to perform keyhole surgery, minimally invasive surgery for aortic root dilation symptoms is less commonly available despite the benefits of having treatment in this way.
The Keyhole Heart Clinic’s Minimally Invasive Surgery is a Proven Solution
At The Keyhole Heart Clinic, we recognised this shortfall long ago and we have developed considerable expertise in this field, offering keyhole surgical solutions that are safe and effective. As recognised leaders in this field, we can assist patients who may be suitable for this type of surgery and help them recover faster. Our expert medical team consist of some of the world’s leading heart surgeons and cardiologists, ensuring that our approach to minimally invasive keyhole surgery is performed by specialists that have the experience and knowledge that is unrivalled in this field.
With the traditional breastbone division approach for those with aortic root aneurysms, you can expect the following:
- Broken breastbone
- Healing time approx. 3 months with no heavy lifting for the duration
- Small risk of bone infection
- Mild to moderate pain experienced
- Visible scarring that is cosmetically less appealing
With keyhole surgery providing a minimally invasive approach, patients benefit from:
- No broken breastbone
- Healing within 7 days, being able to resume regular activity quickly
- No risk of bone infection
- Minimal pain experienced
Having no need for breastbone division or for the aortic valve to be removed and replaced is the ideal solution, and we recommend getting a second opinion if you have been diagnosed with this condition and you need surgery.
Choosing a Better Solution for Your Heart Condition
Here at The Keyhole Heart Surgery, we can assist patients in heart screening if you are concerned that you may be at risk of developing aortic root aneurysms as a result of your family history. We can also regularly monitor you if you have been diagnosed with early aortic root aneurysms in order to ensure that any surgery is timed appropriately.
If you need surgery, we can perform all of the procedures mentioned in this article through a keyhole incision. Feel free to call us anytime, or send us details using one of the contact forms on the website.