Aortic Aneurysm

What Is an Aortic Aneurysm?

An aneurysm (AN-yer-iz-im) is a bulge in a blood vessel. It happens because there's a weak spot in the blood vessel wall. An aortic aneurysm is in the large artery that carries blood from the heart to the body. This artery is called the aorta(ay-OR-tuh).

What Happens in an Aortic Aneurysm?

When a child has an aortic aneurysm, blood flowing through the aorta pushes on the weak spot in the wall. This makes the aorta bulge out. Sometimes the weak spot bulges out so much it gets very fragile. Like a balloon that's blown up too much, the aorta can burst.

What Problems Can Happen?

When doctors know that a child has an aortic aneurysm, they set up regular checkups and tests. If there's a chance an aneurysm might burst, surgeons step in to repair the blood vessel. Checkups and surgery can help stop problems like these before they start:

• Internal bleeding. The aorta is the largest blood vessel in the body. It carries a lot of blood. If it bursts, blood floods into the chest or belly. A burst aneurysm is an emergency. Children need surgery fast.
• Blood clots. Sometimes blood clots form inside an aneurysm. If they break free, they can clog branches of the aorta farther down the body. This is called an embolism (EM-buh-lizm). It can block blood flow to the kidneys, legs, or other body parts.

What Are the Signs & Symptoms of an Aortic Aneurysm?

There may be no signs that a child has an aortic aneurysm. That's why doctors keep a close watch on children who might get one.

Aortic aneurysms can happen in the chest or belly. They have different symptoms.

Aneurysms in the belly are called abdominal aortic aneurysms (AAAs). A child with an AAA may have:

• pain anywhere from the upper belly to the hips
• a pulsing lump in the belly that can be felt through the skin
• high blood pressure
• nausea (feeling sick)
• vomiting (throwing up)
• diarrhea
• belly tenderness (pain with touching or pushing on the belly)

Aneurysms in the chest are called thoracic (thuh-RAS-sik) aortic aneurysms (TAAs). They can't be felt from the outside. Most show up when doctors do tests for a heart problem.

Why Can Kids Get an Aortic Aneurysm?

Kids can have a higher risk for getting an aortic aneurysm if:

• they already have (or had) an aneurysm
• a parent or sibling has (or had) an aneurysm
• they have health conditions that weaken the aorta, such as coarctation of the aortaKawasaki disease, Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome, or tuberous sclerosis
• their aorta was injured by a catheter or other medical device
• they had an infection like endocarditis (an infection of the heart's lining)
  
• they had chest or belly surgery
• they had a whole-body injury, such as a car accident or a fall from a tree or roof
• they had a wound in the chest or belly

How Is an Aortic Aneurysm Diagnosed?

There are lots of ways doctors might find an aneurysm:

• It might show up on an ultrasound scan before a baby is born.
• It could be seen on a CT (computed tomography) scan done for another reason, such as a car accident or belly pain.
• If a child shows signs of heart or artery problems, doctors will do tests to see what's going on. A thoracic aortic aneurysm might show up when doctors do an ultrasound scan of the heart (called an echocardiogram).
• If a child has an abdominal aneurysm, doctors and nurses might notice it during a physical exam. They will then confirm the problem by doing an ultrasound scan, CT scan, or possibly an angiogram, which is a series of X-ray movies taken of the blood vessels.
• Aneurysms can run in families. If your family has a genetic condition that causes them, doctors might test your child for aneurysms.

How Is an Aortic Aneurysm Treated?

After diagnosing an aneurysm, doctors often order tests to get detailed images. These help them know what treatment to recommend.

Doctors treat aortic aneurysms based on:

• the child's age
• the size and location of the aneurysm
• other health issues the child may have
• the cause of the aneurysm, such as a genetic condition

Medicines and Monitoring

When aneurysms are small, children usually don't need treatment right away. Doctors watch to see if the aneurysm gets bigger. If the aneurysm causes high blood pressure, doctors prescribe medicines to keep it in check.

Surgery

When the time is right, surgeons might repair the aorta. To do that, they might:

• open the aorta and cut out the stretched part, then close the aorta
• remove the piece of the aorta with the aneurysm and replace it with special medical tubing or a blood vessel
• repair the aneurysm from inside the aorta using a long, thin tube like those used for cardiac catheterization. This is called endovascular repair. Doctors often do this type of repair for adults, and it may be an option for some older kids and teens.

What Causes an Aortic Aneurysm?

Aortic aneurysms form because something weakens or damages the wall of the aorta. A few babies are born with an aortic aneurysm. These are called congenital aortic aneurysms (CAAs).

How Can Parents Help?

Kids often don't show signs of an aortic aneurysm. But to protect your child from having an emergency, you can:

• Take your child to all well-child checkups.
• If doctors are watching your child for an aneurysm, go to all follow-up visits and testing.
• If your child needs medicine, give it as prescribed. Renew prescriptions before they run out. Ask the pharmacist or your doctor if you're not sure how to give a medicine.
• Tell your doctor if other people in your family have (or had) aneurysms.
• If your child has a genetic condition that causes aneurysms, ask about getting other family members tested. This can reveal an aneurysm before it causes problems.
• If your child had an aneurysm repaired, there's still a chance they could get another one. Follow your doctor's instructions about setting up regular ultrasounds, MRIs, or CT scans.