By Michael Roberts Aortic ANP The Role of the Aortic Nurse Practitioner at the LHCH Commenced September 2011 Patient amp relative clinical and followup support Coordination of Aortic Patient Forum ID: 525941
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Everything you wanted to know about the aorta but were afraid to ask!
By Michael Roberts Aortic ANPSlide2
The Role of the Aortic Nurse Practitioner at the LHCH.
Commenced September 2011
Patient & relative clinical and follow-up support
Coordination of Aortic Patient Forum
Link for GP / dietician / physiotherapy / occupational therapy / cardiac rehab
Advanced practice
Msc and clinically trainedSlide3
Aims
:
Anatomy & Physiology of the Thoracic Aorta
Surgical Procedures
Aortic Dissection
Plans for the future? Slide4
Anatomy & Physiology of the Thoracic Aorta
Blood Flow
The Heart
The Aorta
The Abdomen
Limbs & FeetSlide5
The Heart & the Aortic ValveSlide6
Aortic Root, Ascending & ArchSlide7
The Descending AortaSlide8
The Coeliac AxisSlide9
Other useful arteries!!!
The Hepatic Artery
Lt &
Rt Renal Arteries
Mesenteric Arteries
The Liver
The Kidneys
The GutSlide10
The Iliac Arteries
… to the Iliac arteries that divide downwards, carrying blood to the legs and feet.Slide11
Lets cut right through to the heart of the matter – the surgerySlide12
Thoracic Aortic Aneurysm
Thinning and dilitation of the aortic wall
Life threatening condition
Atherosclerotic in origin
Secondary to Marfan’s, aortitis, trauma, chronic
dissection or infection
Categorized by position on the aortaSlide13
Shape & Location of the Aneurysm
A Fusiform Aneurysm
A Saccular AneurysmSlide14
Aortic Valve & Aortic Root & Ascending
Performed when patient is either symptomatic because of the aortic stenosis or if the aorta is 5.5cm or more. Median Sternotomy. Tissue or Mechanical Valve.Slide15
Thoraco-abdominal aneurysm repairSlide16
Thoraco-abdominal aneurysm repair
Extent I – sub-clavian artery extending to level with the renal arteries
Extent II – sub-clavian artery extending to the bifurcation of the aorta in the pelvis
Extent III – from the middle of the descending aorta extending to the bifurcation of the aorta in the pelvis
Extent IV – upper abdominal aorta and extends to the bifurcation of the aorta in the pelvis
***Bifurcation – to divide into 2 parts**** Slide17
Crawford Classification of Thoraco-abdominal aneurysmsSlide18
TEVAR
(Thoracic Endo-vascular Aortic Repair )
Pre / post op CT imaging
Less invasive femoral approach
For patients unfit for surgery
Thoracic + Vascular surgeons
Spinal drain required
Fabric tube + metal wire stents.Slide19
TAVI (Trans Aortic Valve Implant)
TAVI (Apical / Femoral)
Cardiology + Surgical Procedure
High co-morbidity / older patients
Less invasive than open heartSlide20
Aortic DissectionSlide21
Aortic Dissection (Acute / Chronic)
Dissection
Split in the medial layer of the aorta resulting in two
lumen with active flow in both
Dissecting aortic aneurysm
Dissection in an aortic aneurysm
Aortic dissection that has subsequently become
aneurysmalSlide22
Classification (DeBakey and Stanford)
Stanford Type A
Stanford Type BSlide23
Incidence
Stanford Type A 2 – 3 x commoner than
a ruptured AAA True incidence unknown
Males >Females
80% HypertensiveSlide24
Natural History
50 % Untreated acute Proximal Aortic
Dissections succumb within 48 HRS.
1% per/hour death risk
70% die within 2 months
90% die within 3 – 6 monthsSlide25
Aetiology
Marfans or other heritable elastic tissue disorders:
Turners, Noonan, Ehler-Danlos
Unicuspid / Bicuspid Aortic Valves have 5 x more incidence of disseection
In absence of elastic tissue disorders:
Pregnancy and hypertension
Iatrogenic
Most believe that Atherosclerosis is coincidental rather than
causativeSlide26
Clinical Presentation
Chest Pain: sudden, worst at onset but constant
and may be migratory
Marked anxiety
Hypertension
High incidence of suspicion essential for diagnosisSlide27
Patterns of Chest Pain in DissectionSlide28
Physical Signs
New pulse deficit
New murmur of aortic regurtiation
Hypertension
Hypotension: rupture, tamponade, obstruction of main coronary
arteries
Neurological deficits: paraplegia, ischaemic paralysis, Horner’s
Signs of intrathoracic compression: SVC Syndrome, Vocal cord
ParalysisSlide29
Radiology
Chest X-ray:
bulging of the descending aortic
deformity of the aorta knuckle
displacement of the oesophagus
mediastinal widening
hazy aortic shadow
tracheal or bronchial displacement
pleural effusion
Slide30
Further investigations: CT or MRISlide31
EchoSlide32
Protocol from ward to rehab
Procedure
Stage of Rehab
Aortic Root Replacement +/- AVR
Full Rehab no special treatment
Aortic Root Replacment + Hemiarch awaiting 2
nd
stage
Light active rehab
No pushing or heavy liftingSlide33
Procedure
Stage of Rehab
Thoraco-abdominal aortic repair
Full rehab no special treatment
Type B Dissection
Awaiting surgery
Very light rehab active rehab
Tevar / Evar
(stent)
Light active rehab No pushing or heavy liftingSlide34
Procedure
Stage of Rehab
Tavi
(apical / femoral)
Full rehab no special treatment
Type A repair with residual dissection
Light active rehab No pushing or heavy liftingSlide35
Aortic ANP + Cardiac Rehab Team = Happy PatientSlide36
Contact Details:
Michael Roberts
Aortic Nurse Practitioner
Liverpool Heart & Chest Hospital
0151 600 1616 bleep: 2006
Office Tel No. 0151 600 1006
Email michael.roberts@lhch.nhs.uk