What Is New in Dilatation of the Ascending Aorta? Review of Current Literature and Practical Advice for the Cardiologist

A 61-year-old woman presented with atypical chest complaints. Her sister and brother suffered from type A aortic dissection at 47 and 39 years of age, respectively.1 The diameter of the ascending aorta was 4.6 cm as measured with magnetic resonance imaging (Figure 1). Figure 1. Magnetic resonance angiography of the ascending aorta. The diameter at the level of the ascending aorta measures 4.6 cm. The diameter of the aortic root is normal. Acute dissection of the ascending aorta is often lethal. Even when emergency surgery can be performed, associated morbidity and mortality are high. To prevent dissection of the aorta, timely operation on a patient with a known dilatation of the ascending aorta (for normal values, see Table 1) is advised, along with other supportive measures. The guideline for the management of aortic dissection published by the European Society of Cardiology (ESC) task force in 20012 recommends the following for the prevention of aortic dissection in inherited diseases (Marfan syndrome [MFS], Ehlers-Danlos syndrome, annuloaortic ectasia): lifelong β-adrenergic blockade (Class IB), moderate restriction of physical activity (Class IC), periodic routine imaging of the aorta (Class IC), prophylactic replacement of the aortic root before diameter exceeds 5.5 cm (Class 2A), and prophylactic replacement of the aortic root before diameter exceeds 5.0 cm in patients with a family history of dissection (Class 2A). These ESC recommendations received endorsement by the American College of Cardiology (ACC) in 2001. In recent years, insights into the diagnosis and management of these patients have changed. The purpose of the present article is to summarize these changes, referring to this recent case presented at our clinic. View this table: Table 1. Normal Ascending Aortic Dimensions in Adults In patients with aortic dilatation, the aortic wall can be weakened by cystic media degeneration. The media displays loss of smooth muscle cells and fragmentation …