What is an ascending aortic aneurysm, the condition that killed Grant Wahl?

Posted at 11:12 AM, Dec 14, 2022

Soccer writer Grant Wahl’s death led to much speculation as he died at age 49 last Friday during a Men's World Cup match in Qatar.

His sudden death initially caused Wahl’s brother Eric Wahl to suggest foul play was involved, a claim he later retracted. It also added fuel to conspiracies that COVID-19 vaccinations cause people to die suddenly.

But Wahl’s autopsy suggests both are unlikely.

According to Wahl’s wife,Dr. Céline Gounder, the autopsy showed he died from a slowly growing, undetected ascending aortic aneurysm with hemopericardium.

According to the Centers for Disease Control and Prevention, aortic aneurysms cause about 10,000 U.S. deaths annually. Nearly two out of three deaths are among males.

The aorta is the large artery that goes from the heart into the abdomen. It is the heart’s main artery that can carry a lot of blood to the rest of the body.

Dr. Milind Desai, medical director of the Center for Aortic Diseases at Cleveland Clinic, likened an aorta aneurysm to a balloon exploding after expanding. He said it can take years of the artery expanding before it finally ruptures.

“Nature has made it to be a resilient structure,” Desai said about the aorta. “It has three layers; it is a muscular structure that contracts and relaxes and if the aorta has a weakness in the wall, if it starts to bulge, it starts to dilate, and then it starts it reach a certain size, say 5 centimeters, that is when it becomes an aneurysm.”

Desai said oftentimes, the artery grows without a person knowing.

“In a small proportion of people, the pressure of the aorta and the blood tears through the wall and separates the three walls - a medical emergency, surgical emergency,” he said about aortic dissection. “In a smaller proportion of people, it may burst and rupture and go to the next available cavity. That is what happened in Grant Wahl. He had an aortic rupture and all the blood accumulated in the pericardium (lining of the heart).”

Desai said tests conducted during a normal annual exam likely would not indicate someone’s artery is expanding. He said the No. 1 cause for this condition is genetics. High blood pressure and obesity can “add fuel to the fire,” he said, in addition to rheumatologic diseases.

“EKG may not pick up on this; X-Ray is not very sensitive,” he said. “An astute diagnostician might find a family history and go looking, but in reality, the way to make this diagnosis is by imaging. You start with an echocardiogram and if there is suspicion that concerns them, you move to either CT scan or MRI.”

Desai said periodic imaging is used for someone with a known family history, even if there are no physical signs of disease.

If someone has a dilated aorta and it’s known, Desai said doctors would work to lower the person’s blood pressure, get their weight to a healthy level and monitor. Surgery would be needed once the dilation reaches a certain level. But he said surgery would be done preemptively before it becomes a medical emergency.

Wahl reported days before his death that he was suffering from chest discomfort and bronchitis. While Desai said bronchitis would not have caused his aorta to rupture, if the vessel starts to leak, it could cause chest pain.

Gounder is a world-renowned infectious disease doctor who advised then-President-elect Joe Biden before his inauguration. She dispelled notions that his disease was caused by vaccinations.

It was an assessment shared by Desai.

“This disease in very high, near certain likelihood, had nothing to do with the vaccine,” he said. “This is something he had to be predisposed to. For an aorta to grow to a level to it ruptures, it would have to be pretty big and it would have had to grow over years, if not decades.”