Diagnosis is usually obvious from the chest radio¬graphy and aortography. A contrast-enhanced CT scan is accurate in detecting and sizing thoracic aneurysms as well as for monitoring growth. Magnetic resonance imag¬ing (MRI) is also useful.

B. Treatment
1. Medical
Because surgical therapy carries a high mortality rate and is usually not advisable until ascending aneurysms are larger than 5.5–6 cm or larger for descending aneurysms, medical treatment has an important role. A beta-blocking drug is strongly recommended to reduce dP/dt and for the control of blood pressure. Beta-blockers reduce cardiac ejection velocity and hydrodynamic stress. A randomized study of 70 patients with Marfan syndrome treated with propran-olol versus no beta-blocker and monitored over a 10-year period showed the following: the treated group showed a significantly lower rate of aortic dilatation, aortic dissec¬tion, and aortic regurgitation; fewer deaths; aortic root greater than 6 cm; and significantly lower mortality rates from the 4-year point onward. This study shows that blood pressure must be aggressively controlled.
2. Surgical
Significant risks are associated with thoracic aortic surgery, particularly in the arch and descending aorta and surgery is usually deferred for symptomatic patients or those with aneurysms greater than 6 cm. Aneurysms are usually resected and replaced with a prosthetic sleeve of appro¬priate size. Postoperative complications include heart attacks, heart failure, stroke, renal failure, respiratory failure, and infection.

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