Our Mission : Lifelong Care for Thoracic Aortic Disease
Our mission is to provide expert risk assessment, medical management and integrated clinical care for individuals and families with thoracic aortic diseases and cardiac valve abnormalities, including those with an enlarged aorta, aortic dissection, connective tissue and genetic aortopathies, bicuspid aortic valve and bicuspid aortopathy, and other congenital vascular disorders. The goal is a well-integrated, consistent treatment approach toward the best outcomes possible for the patient and their family members. Patients and their families are partners with their treatment team and encouraged to make informed decisions. Thus, education is a cornerstone of our care and we ensure that primary doctors, and other referring co-managing physicians, are kept informed every step of the way. Patients with aortic diseases who are diagnosed and managed appropriately can expect to lead relatively normal lives, but lifelong management is required.
- Evidence-based best medical therapy incorporating the latest research and recommendations, including the ACC/STS Thoracic Aortic guidelines for conditions such as aortic aneurysms, bicuspid aortopathy, aortic dissections, and inflammatory aortopathies. Medications, control of risk factors and lifestyle modifications may slow aneurysm expansion and improve long term outcomes. Multidisciplinary care coordination may be required with specialists in medical genetics, ophthalmology, connective tissue disorders, and surgery.
- Accurate reproducible aortic imaging by gated MRI and the lowest radiation dose gated CT if necessary, indexed to body surface area and height, and assessed for rate of change. If indicated, extra-aortic vascular imaging for aneurysms, tortuosity, and malformations. Both our co-directors have achieved the highest Level III training in noncontrast 3D MR angiography, contrast MRA, and Cardiovascular CT angiography, and review all measurements for accuracy. Careful accurate measurements are, beyond symptoms, the best current intervention criteria.
- Complex pre-surgical risk/benefit analysis in collaboration with surgeons, for continued medical versus elective surgical repair involves size criteria, rate of growth, aortic morphology, underlying causes such as bicuspid, connective tissue, non-syndromic genetic factors, as well as family history, and any concomitant heart or extra-aortic disease.
- Care transition and coordination between Outpatient and Inpatient, in collaboration with multiple specialists. Post aortic surgery imaging surveillance is important to monitor for complications and additional risks, especially after dissection.
- Family risk assessment and screening if appropriate. Screening of first-degree relatives of persons with bicuspid aortic valve, Marfan syndrome, or familial thoracic aortic aneurysm and dissections is warranted because of genetic predilection for aneurysms. Family screening is an ACC/AHA class I recommendation for family members with bicuspid aortopathy. Review of any pathology and referral for genetics investigation and connective tissue evaluation for patients with suspected fibrillinopathies or collagenopathies, nonsyndromic genetic disorders are relevant since certain genes can affect other segments of the vascular system and can result in intracranial aneurysms, early onset coronary artery disease, and stroke.
- For families with children, pediatric cardiovascular evaluation may be recommended.
- Education and support of patients and their families can include USB key chain drive with prior imaging studies, operative reports and medical records, emergency preparedness kit, and medic alert bracelet.