ascending aortic aneurysm; aortic root dilation

Diagnostic procedures

• echocardiogram
  • valve morphology & aortic root dimensions
  • reassessment if aortic root or ascending aorta diameter is > 4.0 cm
    • every 3-5 years; annually 3.5-4.4 cm (MKSAP20)
    • annually if aortic root or ascending aorta diameter is > 4.5 cm
      • every 6 months if 4.5-5.4 cm in diameter (MKSAP20)
      • every 3 months if enlargement of 0.3 cm over the past 6 months (MKSAP20)
      • every 3 months if aneurysm is approaching repair threshold (MKSAP20)
    • new or changing symptoms & pregnancy are indications for earlier echocardiography

Management

• surgical repair at a diameter of > 5.5 cm*
  • some surgeons recommend repair at 4.5 cm
• patients requiring aortic valve replacement may also need aortic root surgery
  • surgical repair* indicated when aortic root diameter
    • > 5.5 cm
    • > 5.0 cm with additional risk factor for aortic dissection
    • > 4.5 cm with severe (not moderate) aortic stenosis or aortic regurgitation

* repair may be indicated at 4.5-5.0 cm in Marfan syndrome & Ehlers-Danlos syndrome

* endovascular repair not recommended unless patient is a prohibitive surgical risk

More general terms

• thoracic aortic aneurysm