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Bicuspid Aortic Foundation Observes Thoracic Aortic Disease (TAD) Awareness 2011

In December, news reports chronicled the illness and hospitalization of Richard Holbrooke. Among them was one from the Washington Post on December 12th: “Special envoy Richard Holbrooke has surgery for tear in aorta.” The next day, December 13th, Richard Holbrooke died. In observing TAD Awareness 2011, the Bicuspid Aortic Foundation is committed to sharing information aimed at reducing the incidence of aortic emergencies and their too-often tragic consequences.

Laguna Niguel, CA, October 03, 2011 --( Thoracic Aortic Disease -- Aneurysm, Dissection, and Rupture

Abnormal bulging (aneurysm), tearing (dissection) and rupture of the aorta in the chest are manifestations of thoracic aortic disease (TAD). The highest risk scenario for someone with TAD is an aortic emergency, also called acute aortic syndrome. This life-threatening situation is where Richard Holbrooke found himself while at work on the morning of December 10th, 2010.

Despite advances in treatment, aortic disease is known to take thousands of American lives each year. Preliminary numbers from the CDC report 10,581 aortic-disease related deaths in the US in 2009. For the aorta in the chest, the actual death toll may be considerably higher than recorded due to the potential for confusion with death from heart attack.

Finding TAD Earlier

When the CDC’s mortality data are compiled for the year 2010, the tragedy of Richard Holbrooke’s death, along with thousands of others, will be attributed to aortic disease. Still others who died of TAD that year may be counted under acute myocardial infarction – heart attack. The question before us – the challenge – is how to intervene earlier, before the emergency, and help those with TAD under more favorable conditions. The difference in outcome is striking. For aortic dissection, the immediate mortality rate is 45%, with survivors facing the lifelong consequences of a chronic aortic condition. Complete aortic rupture essentially causes instant death from massive bleeding. In contrast, the mortality is as low as 1% for elective thoracic aortic surgery in expert centers.

Known Risk Factors Today, Greater Understanding Tomorrow

There is tremendous need for greater precision in identifying and proactively altering the course of TAD. While ongoing research gives hope for the future, focusing today on known TAD risk factors can inform and warn those groups who are most vulnerable to dissection or rupture.

The known risk factors include the following genetically-based conditions: bicuspid aortic valve families, familial thoracic aortic aneurysm and dissection (TAAD), Ehlers-Danlos syndrome, Loeys-Dietz syndrome, Marfan syndrome, and Turners syndrome. Additional risk factors include bovine aortic arch anatomy, hypertension, inflammatory conditions, and cocaine use.

In addition, in the absence of coronary artery disease symptoms in the chest may be due to aortic disease and merit systolic imaging of the aorta. A family history of TAD should be a red flag for living blood relatives. Exploring any family history of sudden deaths thought to be from heart attacks may raise important questions about the thoracic aorta in time to prevent the loss of multiple family members to TAD.

Looking for TAD

Sir William Osler, MD, FRS, in Volume IV of Modern Medicine (1908), devoted a chapter to aneurysms. This chapter is the source of the often quoted “There is no disease more conducive to clinical humility than aneurism of the aorta.” In the same chapter, describing the challenges of diagnosis by physical examination, Osler quoted the words of Jenner: “‘More mistakes are made by not looking than not knowing.’” Today, over a century later, with CT, MRI, and echocardiography available, the question remains – are we looking for aortic disease in the chest? Are we using today’s knowledge to find the vulnerable before catastrophe strikes?

Thoracic aortic disease continues to challenge individuals, families, and the physicians who care for them. Knowledge of TAD risk factors can help individuals and families discuss their aortic health with physicians. As part of the 2011 TAD Awareness Campaign, the Bicuspid Aortic Foundation Blog features a series of articles about those with TAD. Doug Grieshop, Richard Holbrooke, Derek Owens, Jen Lopez, and others -- their stories are compelling expressions of the thin line between life and death, tragedy and triumph, and the power of TAD to alter the course of our lives forever.

For additional information, please contact the Bicuspid Aortic Foundation.

Contact Information
Bicuspid Aortic Foundation
Arlys Velebir
(949) 371-9223

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