The .gov means its official. For example, mutations in ACTA2 alter the function of smooth muscle cell actin and are responsible for 14% of inherited TAAs [6]. It was 4.7 cm in 2020 and 5.0 in 2021 and the descending was 3.4 cm at the RPA level. The pressure of blood pumping through the artery causes a balloon-like bulge in the weak area of your aorta. Data suggests that this process can also occur in congenital disease such as tetralogy of Fallot [14] and bicuspid aortic valve (BAV). British Heart Foundation (BHF). The ascending aorta ( AAo) [1] is a portion of the aorta commencing at the upper part of the base of the left ventricle, on a level with the lower border of the third costal cartilage behind the left half of the sternum . Elective Ascending Aorta and Aortic Arch Open Surgery: Volume and In-Hospital Mortality. The genetics and genomics of thoracic aortic disease. A maximal aortic root/ascending aorta diameter of greater than 45mm to 50mm with the following: Rapid aortic root growth of more than 5mm per year. According to the newest guidelines, all pregnant women with TAA should be under strict blood pressure control (<120/80mmHg) and a monthly or bi-monthly echocardiographic measurement of the ascending aorta should also be performed to follow the growth rate [46]. Aorta: dilated vs aneurysm? Elastic fiber in the medial layer of the aorta allows continuous forward flow during the whole cardiac cycle. It extends up and over the heart. Ascending Aortic Dilation - Ascending Aortic Aneurysm Posted by rory @rory , Apr 2, 2018 I was diagnosed in 2012 with ascending aorta dialation of 4.1 cm. 2004;110 (17): 2747-71. Therefore, there is variability with the determination of a specific diameter at which the risk of complications increases. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. The purpose of this review is to explain the main aspects (etiology, pathophysiology, diagnosis) of this disease and to summarize the most recent developments in its management. Its attached to your heart and plays an essential role in helping your heart deliver oxygen-rich blood to your entire body. 2015 March;6:91-100. Isometric exercises include weight lifting, sit-ups, and push-ups. How your heart works. A mild to moderately dilated ascending aorta was defined as having an aorta ascendens dimension between 40 mm to 45 mm on the computer tomography. The aorta is the pipe that helps oxygenated blood get from your heart to every part of your body from your brain to your digestive tract. In addition, the MYH11 gene affects the C-terminal coiled-coil region of the smooth muscle myosin heavy chain, a specific contractile protein of smooth muscle cells [7] and increases TAA formation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). It is therefore essential to diagnose a pathologically dilated ascending aorta in a timely fashion and to ensure a proper follow-up in order to start medical therapy and recommend prophylactic surgical repair. Thoracic aortic aneurysms (TAA) and its associated complications are life threatening clinical entities that rank in the top 20 leading causes of mortality in the United States (15th leading cause of death in people over 65years old) (CDC, http://webapp.cdc.gov/cgi-bin/broker.exe). As has been already mentioned in this review, patients with Marfan syndrome tend to have acute aortic syndromes at a younger age and at smaller aortic diameters than other patients (refer to Table2.2). Sherratt M.J., Baldock C., Haston J.L., Holmes D.F., Jones C.J., Shuttleworth C.A. Cleveland Clinic is a non-profit academic medical center. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Weerakkody Y, Tatco V, et al. Choice of surgical procedure has not been extensively studied. In another study [1], freedom from re-operation was approximately 90% in patients who underwent VSP. Likewise, the latest guidelines from the ACCF recommend prophylactic surgery when the ascending aorta reaches 4.2cm (measured by transesophageal ultrasound) albeit being based on a C level of evidence [46]. Familial patterns of thoracic aortic aneurysms. Once dilation h. Read More When aortic root or ascending aorta dilation is initially diagnosed by TTE, a multiplanar CT/CMR scan is recommended to confirm TTE measurements, to rule out aortic asymmetry, and to have a baseline reference in the follow-up. Biddinger A., Rocklin M., Coselli J., Milewicz D.M. For aorta assessment, images should be obtained in the parasternal long axis view and the aorta size measured at the onset of the QRS complex at 4 levels of the ascending aorta: annulus, sinuses of Valsalva, ST junction, and ascending tubular aorta (maximal diameters). They are greatly dependent on the predisposing condition and, as discussed later, on the management of this disease. There have been many studies that tried to establish a specific size at which surgery should be performed, but it has been shown that this criterion depends on the underlying pathology, the rate of growth, the family history and to some extent the individual morphology of each patient. It is therefore safe to recommend prophylactic surgery when the aorta reaches a diameter of 5.5cm unless the patient falls under the category of Marfan syndrome, bicuspid aortic valve, positive family history or fast growers in accordance with the newest American guidelines [46]. Pape L.A., Tsai T.T., Isselbacher E.M., Oh J.K., O'gara P.T., Evangelista A. Aortic diameter > or =5.5cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD). Wenstrup R.J., Meyer R.A., Lyle J.S., Hoechstetter L., Rose P.S., Levy H.P. Careers, Unable to load your collection due to an error. 7 The difficulties in decision-making and management of these patients would be made easier if more information is available about each individual's aortic . David T.E., Feindel C.M., Webb G.D., Colman J.M., Armstrong S., Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. Aneurysmal dilatation is considered when the ascending aortic diameter reaches or exceeds 1.5 times the expected normal diameter (equal to or greater than 5 cm). In a casecontrol study done by Keane et al., BAV patients were matched with TAV patients with similar valve function (AR, AS, normal) and the results showed that patients with BAV had aortic dilatation at a younger age and earlier than their matched controls [29]. It is suggested that preoperative dilation of the ascending aorta is more common in patients with R/N fusion than in patientswith R/L and TAV but is not significantly different between all groups in the early follow-up period. Zehr K.J., Orszulak T.A., Mullany C.J., Matloobi A., Daly R.C., Dearani J.A. Etiologies of ascending aortic dilatation. (2009) ISBN:3131477814. These results led some experts to develop other measures that can possibly better predict the risk of complications. In addition, some authors suggest using the aortic size index [2] which takes into account the body surface area, thus minimizing classification of normal aorta as pathologically dilated and vice versa. A maximal aortic root/ascending aorta diameter of greater than 44mm if pregnancy is desired. 2018 Feb;6(3):66. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. Ascending aortic aneurysm is a lethal disease. Annual imaging assessment of the entire aorta is recommended. Family members of these patients should be screened for BAV. 1-ranked heart program in the United States. It seems to be transmitted in an autosomal dominant pattern with variable degree of penetrance. Advertising on our site helps support our mission. 1. Haouzi A., Berglund H., Pelikan P.C., Maurer G., Siegel R.J. Heterogeneous aortic response to acute beta-adrenergic blockade in Marfan syndrome. In this study, patients with family history of TAA, aortic dissection or sudden death exhibited higher prevalence of TAA development and sudden death. In 2021, Cleveland Clinic surgeons performed 670 elective open procedures to repair the ascending aorta and aortic arch. From the Framingham Heart Study (echo sub-study), aorta diameter increases 0.1cm per 10years at the aortic root after the age of 25 [22]. Marfan syndrome patients) who require serial evaluations even in the context of newer generation low dose CT scanners. This review also allowed us to realize the many developments that have been made in recent years in the understanding of pathologic mechanisms of this disease. It is shaped like a walking cane with a curved handle. Hypertension and smoking appear to accelerate the process by increasing elastolytic enzymes in the aortic medial layer [13]. The ascending aorta is the first part closest to your heart. In chronic aortic pathology, more controversies and conflicts exist among the current CGs. Dilation of the ascending aorta entails a high risk of dissection or aortic rupture in the absence of surgical treatment. In contrast, an aneurysm is defined as a localized dilation of the aorta that is more than 50% of predicted (ratio of observed to expected diameter 1.5). The ESC recommends that in patients with Marfan's syndrome, surgical intervention is offered once the aortic . Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-20248, View Frank Gaillard's current disclosures, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, post stenotic dilatation of ascending aorta, thoracic aortic dilatation (differential), D-loop transposition of the great arteries, L-loop transposition of the great arteries. In some cases, familial TAA appears to be an aggressive aortic disease and family history of TAA, aortic dissection or sudden death needs to be considered as risk factor for rapid growth of TAA and its complications. You also need to continue modifying your risk factors as you are doing. Published data on arteries diameter in healthy population are often scant or variable because of different imaging modalities used for measurement. Consider surgery if greater than 45mm. Mortality rates for surgical repair with valve replacement. The internal elastic lamina separates the intima from the media. Mean increase in aorta size in patients with Marfan syndrome. However, there are very few studies on patients with other etiologies. Aneurysms with a maximum minor-axis diameter of 60mm or greater, Aortic aneurysms accompanied by pain where the maximum minor-axis diameter is 50 to 60mm, For patients who have an indication for surgery on the aortic valve, lower thresholds can be used for combining surgery on the ascending aorta.. Mubarik A, Law MA. The purpose of this study was to investigate the benefit of aortic volumes compared to diameters or cross-sectional areas on three-dimensional (3D) ma Dilation of the aortic root imparts a significant higher risk of adverse events. Aortic dissection is relatively uncommon. Roman M.J., Rosen S.E., Kramer-Fox R., Devereux R.B. Multiple etiologies of AoD exist, such as Marfan syndrome, bicuspid aortic valve, Ehler-Danlos syndrome, infections, and idiopathic conditions. Nonstandard Abbreviations and Acronyms Clinical Perspective What Is New? The spectrum, management and clinical outcome of EhlersDanlos syndrome type IV: a 30-year experience. Your descending aorta travels back down into your abdomen (belly). In addition, according to Laplace's law, the dilation of the aorta increases wall tension, triggering vascular wall remodeling and even further aortic dilatation. As has been previously mentioned, complications of ascending aorta aneurysms can be disastrous even if diagnosed promptly and properly managed. The site is secure. 9,10 Aortic dilation involves the aortic root, but effacement of the sinotubular junction with enlargement of the proximal ascending aorta is often present. LoeysDietz syndrome is an autosomal dominant genetic disorder mainly associated with mutations of the genes responsible for the transforming growth factor B receptors 1 and 2. A prospective TEE study has compared the growth rates of the dilated ascending aorta (4.06.0cm) between patients with normal functioning aortic bicuspid and tricuspid valve. The ascending aorta is the first part of the aorta, which is the largest blood vessel in your body. The physiological effect of beta blockers on the natural history of the dilated ascending aorta is not clearly understood, and a combination of reduced wall stress and vascular remodeling has been proposed. According to the CDC, the incidence of ascending TAA is estimated to be around 10 per 100,000 person-years. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. Hartnell G.G. The ascending aortic aneurysm: When to intervene?. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Arterial tortuosity syndrome is an autosomal recessive disorder characterized by tortuosity and aneurysm formation in the major arteries caused by a deficiency in glucose transporter GLUT 10 causing an upregulation of TGFBR1 signaling [11]. One should monitor the size of your aortic root and ascending aorta in serial MRA/CTA studies. Very few studies succeeded in establishing a growth rate pattern for patients with BAV, and the evidence remains contradictory. the mean age of death of these patients was at 26 and was caused by thoracic aortic dissection and the mean age for first vascular surgery was 19.8years. While this subject is not very well studied, pregnancy seems to predispose to arterial wall degeneration by the excess release of estrogen and progesterone [60]. Coady M.A., Rizzo J.A., Hammond G.L., Mandapati D., Darr U., Kopf G.S. As Table9, Table10 show, there is decreased 30-day and 5years mortality in patients who undergo the valve sparing procedure. shows that mean annual ascending aorta growth rate is 0.050+/0.089cm [34]. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. The ascending aorta is the first part of the aorta, which is the largest blood vessel in your body. If the first test was a CT and now the second CT test indicates it has gone from 3.9 to 4.3, the rate of growth is about .4 centimeters in a year. EhlersDanlos regroups a multitude of connective tissue disorders characterized by laxity of the Joints and skin disorders. demonstrated that 21.5% of TAA was found in patients with family history of TAA [37]. In adults, an ascending aortic diameter greater than 4 cm is considered to indicate dilatation 4. Etiology. Elastic fiber in the medial layer of the aorta allows continuous forward flow during the whole cardiac cycle. In a study by Meijboom et al., 1 in 7 men had a faster yearly growth rate (0.15cm compared to 0.036cm) and 1 in 9 women (0.18cm compared to 0.027cm) [33]. government site. It is approximately 5cm long and is composed of two distinct segments. In: StatPearls [Internet]. For this reason, screening with CT scanning is not routinely recommended, but it is the imaging method of choice to diagnose complications of ascending TAA dilatation and for preoperative visualization of the entire aortic anatomy. The https:// ensures that you are connecting to the Advantages and disadvantages of different imaging modalitiesa. An aneurysm occurs when an artery wall weakens, causing it to bulge or dilate abnormally. If an aortic aneurysm ruptures, it can cause life-threatening bleeding. Of course, for athletes who have undergone sternotomy, adequate time should be allowed for wound healing and stabilization. For example, a novel method that takes into account the body surface area called the aortic size index (ASI), measured by MRI, by dividing the maximal aortic diameter with the body surface area [2]. Sawabe M., Hamamatsu A., Chida K., Mieno M.N., Ozawa T. Age is a major pathobiological determinant of aortic dilatation: a large autopsy study of community deaths. This portion has two small branches. For instance, the recent ACC/AHA CG for the management of valvular heart disease contain a class 1 (level of evidence B) recommendation for operative repair of a dilated ascending aorta of 5.5 cm or greater if associated with a bicuspid aortic valve . In the same study, we see that the odds ratio of acute dissection for an aorta between 5.0 and 5.9cm was not significantly increased but that it jumps to a statistically significant 8.84 when it exceeds 6.0cm. Risks of aortic dissection and/or rupture were significantly correlated with the aortic diameter and age in patients with a moderately dilated ascending aorta. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Coady M.A., Rizzo J.A., Goldstein L.J., Elefteriades J.A. The procedure involves excision of the ascending aorta and underside of the aortic arch, and placement of a thoracic aortic stent graft into the descending aorta at the time of arch repair. Transthoracic echocardiography (TTE) provides a simple non-invasive technique to evaluate the aortic root, proximal ascending aorta, aortic valve and left ventricular morphology and function in the vast majority of patients. Aortic dilatation is a progressive condition that results from aging and many pathological conditions that induce degenerative changes in the elastic properties, leading to the loss of elasticity and compliance of the aortic wall [].Indeed, there is a linear relationship between maximal aortic diameter and aortic dissection or rupture risk []. TAA is a silent disease that needs to be recognized early in its course and followed closely in order to recommend appropriate preventive and prophylactic therapy in a timely manner. Ascending aortic dilation is a condition in which the aorta, the major blood vessel that carries blood from the heart to the body, enlarges. Patients with aortic root or ascending aortic dilation that has not yet exceeded the threshold for surgical intervention require serial evaluations. Imaging of aortic aneurysms and dissection: CT and MRI. It moves in an upward direction until it becomes the aortic arch, which would be the canes handle. Bechtel J.F., Erasmi A.W. In the study by Loeys et al. Nearly all studies found that hypertension increases ascending aorta dilatation in pre-existing TAAs and predisposes to the formation of TAA. Nevertheless, it is very important to encourage cardiovascular risk factor reduction in patients with TAA especially hypertension and dyslipidemia. It carries oxygen-rich blood from your heart to the rest of your aorta. Guo D.C., Pannu H., Tran-Fadulu V., Papke C.L., Yu R.K., Avidan N. Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. An ascending aortic diameter 4 cm is considered dilatation 7. It comes out of your heart and pumps blood through the aortic arch and into the descending aorta. Mortality rates for surgical repair with valve sparing surgery. Circulation. Familial thoracic aortic aneurysms and dissectionsincidence, modes of inheritance, and phenotypic patterns. Federal government websites often end in .gov or .mil. The aorta is the main blood vessel that carries blood away from your heart and to your body. J Thorac Cardiovasc Surg 2004 (Marfan patients), David et al. If it enlarges to 2.5 or 3 inches, it is considered mildly dilated. Aronow WS. The aorta is considered pathologically dilated if the diameters of the ascending aorta and the aortic root exceed the norms for a given age and body size. . Up to 28% of patients with EDS (all types confounded) present with ascending aorta dilatation [40]. Thelen M, Erbel R, Kreitner K et-al. Among the 113 patients studied, 86 had bicuspid and 27 had tricuspid valve and there was no difference in the rate of growth between the two groups [30]. Lower threshold of aortic diameter for surgery should be considered for patients with aortopathy related to congenital etiologies. Fedak P.W., Verma S., David T.E., Leask R.L., Weisel R.D., Butany J. As shown in Table4, the results varied widely, ranging from 0.027cm per year up to 0.2cm per year. The newest American guidelines recommend prophylactic surgery for patients with Marfan syndrome in 6 settings [46]: Some references even suggest lowering the threshold for surgery to all patients with Marfan syndrome to 4.5cm based on data showing that some dissections occur below the threshold aforementioned and given the reduction of mortality associated to the surgery in high volume centers. Coady M.A., Davies R.R., Roberts M., Goldstein L.J., Rogalski M.J., Rizzo J.A. It leaves the heart and forms an arch. This finding is also corroborated by another study, in which beta blockers are compared to the ACEI enalapril [52], the latter showing slower rate of aortic growth, fewer adverse outcomes and decreased side effects in patients with Marfan syndrome. This formula allowed to identify 3 different risk groups: those with an ASI higher than 4.25cm/m2 experienced a sevenfold increase in the incidence of aortic complications. It can cause aortic dilation aka aneurysm. Patient who is newly diagnosed of TAA needs to have another imaging in 6months to determine the growth rate. CT or echo? It has also been noted in certain studies that there are two specific subsets of patients in terms of growth rate: fast growers and slow growers. Several studies have examined the benefits of VSP versus VRP in patients with Marfan syndrome (refer to Table9, Table10). Gillum R.F. Please monitor them and your lipid profile as advised by your cardiologist. Lazarevic A.M., Nakatani S., Okita Y., Marinkovic J., Takeda Y., Hirooka K. Determinants of rapid progression of aortic root dilatation and complications in Marfan syndrome. Ascending aorta diameter greater than 50mm. When the aorta reaches a diameter of 5.0cm. Combined with cardiac MRI, this technology can better assess ventricular function, aortic valve function and aortic root anatomy. Aortic dilation is often found during a routine physical exam. The aorta is the large blood vessel that carries blood from the heart to the body. Most studies done so far seem to show an underlying congenital anomaly in the aortic media associated with BAV that predisposes these patients to develop aortic dilatation with an aggravation induced by the valve dysfunction. Multidetector CT of Thoracic Aortic Aneurysms1. The ascending aorta begins right after the left ventricle of the heart and contains the aortic heart valve, which is a flap that opens and closes to allow blood to enter the aorta from the left ventricle. Other mutations can affect both the structure and the metabolic homeostasis of the vascular wall. A retrospective study (that included a few patients with Marfan syndrome) showed that the median size associated with an increased risk of aortic dissection, rupture or sudden death was 6.0cm [45]. Benedetto U., Melina G., Takkenberg J.J., Roscitano A., Angeloni E., Sinatra R. Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis. How common is aortic root dilation? Different studies have tried to establish the growth rate of the ascending aorta in these patients. Diameter of ascending aorta at timing of complications. The rate of growth is also affected by the location of aneurysm. Milewicz D.M., Regalado E. Thoracic Aortic Aneurysms and Aortic Dissections. Aneurysmal dilatation is considered when the ascending aortic diameter reaches or exceeds 1.5 times the expected normal diameter (equal to or greater than 5 cm). In contrast, another study involving 514 patients comparing patients with BAV (70) to patients with TAV(445) showed that patients with BAV had a higher growth rate (0.19cm/yr compared to 0.14cm/yr) and higher surgical repair rate than TAV patients (72.8% vs 44.8%). Other mutations alter the regulatory mechanisms that inhibit the activity of the TGF-B pathway such as the mutation of GLUT10, a glucose transporter whose deficiency is associated with arterial tortuosity syndrome [11] or the mutation of the SMAD3 gene that encodes a protein necessary for the signaling downstream of the TGF-B pathway [12]. Pomianowski P., Elefteriades J.A. Oderich G.S., Panneton J.M., Bower T.C., Lindor N.M., Cherry K.J., Noel A.A. 1 That said, possible symptoms include chest, abdominal, or back pain, dyspnea, cough, dysphagia, hoarseness, claudication, and cerebrovascular events. As can be seen in Table3, many imaging modalities can be used to image the ascending aorta. This can cause the aorta to rupture, which is a life-threatening condition. The aorta is divided into two main segments: thoracic and abdominal. A ruptured aneurysm can lead to life-threatening internal bleeding. Aortic dilatation could be easily attributed to hemodynamic abnormalities across an abnormally shaped valve but many studies seem to show that valvular dysfunction is not significantly related to increased aortic size. This larger study confirms the findings of a smaller study (n=17) that showed a beneficial effect of losartan on the rate of progression of TAAs [54]. Women with childbearing potential (see section on pregnancy). Bicuspid aortic valve is associated with valvular complications (aortic stenosis or regurgitation) as well as vascular complications such ascending aorta dilatation beyond the sinotubular junction and up to 33% will develop serious complications [25]. Usefulness of enalapril versus propranolol or atenolol for prevention of aortic dilation in patients with the Marfan syndrome. The valve sparing procedure can be done following the David technique (aortic valve reimplantation) or the Yacoub technique (aortic valve remodeling). As Clouse et al. Diameters of the thoracic aorta throughout life as measured with helical computed tomography. Aortic dilation was defined as observed diameter 25% greater than expected for sex, age, and body size; aneurysm was defined as observed diameter 50% greater than expected. Patients are encouraged to perform aerobic exercise with moderation. Meijboom L.J., Timmermans J., Zwinderman A.H., Engelfriet P.M., Mulder B.J. They may be tube shaped or round. For example, patients with Marfan syndrome should get prophylactic repair when the ascending aorta reaches 4.0 to 4.5cm and patients with BAV should get it when the aorta reaches 4.5 to 5.0cm. Aortic aneurysms include: Abdominal aortic aneurysm. Your two main coronary arteries branch off of the ascending aorta. were the first who reported familiar aggregation of TAA [36]. In a recent study, mean carotid intimal media thickness as well as epicardial adipose tissue were associated with ascending aorta dilatation [16]. When this enlargement reaches a critical size, there is a risk of it rupturing or tearing, leading to a life-threatening situation. From the arch, the aorta moves downward through the chest and abdomen. J. Keane M.G., Wiegers S.E., Plappert T., Pochettino A., Bavaria J.E., Sutton M.G. 2009;193 (4): 928-40. If you have a family history of heart problems, or youre over the age of 65, talk to your healthcare provider about reducing your risk for problems in your ascending aorta. Annals of Translational Medicine. MR angiography is an imaging modality that provides accurate measurement and definition of the entire aorta anatomy. We can prevent these complications by screening asymptomatic patients. The authors of the main study on aneurysm syndromes in patients with LoeysDietz syndrome recommend prophylactic surgery at experienced centers when the aorta reaches 4.0cm [10]. Get useful, helpful and relevant health + wellness information. In addition, it is contraindicated in patients having metallic parts in them and in patients with advanced renal failure because of the possible risk of systemic nephrogenic fibrosis related to gadolinium injection. Biddinger et al. Feared events include aortic dissection or rupture, pericardial hemorrhage, cardiac tamponade and occlusion of aortic branches. In case of dilatation of the ascending aorta >4.0 cm, evaluation of a possible connective tissue disease should be performed by a multidisciplinary team (cardiologist, geneticist, and ophthalmologist). When the aorta is weak, blood pushing against the vessel wall can cause it to bulge like a balloon (aneurysm). Ascending aorta diameter between 46 and 50mm with: Progressive dilation of more than 2mm per year as confirmed by repeated measurements. While there were no official guideline and no prospective study to confirm it, most experts agree that women who wish to become pregnant should get prophylactic surgery at earlier stages of their disease. Chaudhry S.S., Cain S.A., Morgan A., Dallas S.L., Shuttleworth C.A., Kielty C.M. Literature was obtained through online health related search engines (PubMed, MEDLINE) by including the following keywords: ascending aorta aneurysm, thoracic aneurysms, Marfan syndrome, bicuspid aortic valve, familial thoracic syndrome, aortic dissection, aorta imaging and aortic aneurysm guidelines. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497177/, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497177/), https://www.bhf.org.uk/informationsupport/how-a-healthy-heart-works, (https://www.bhf.org.uk/informationsupport/how-a-healthy-heart-works), https://www.ncbi.nlm.nih.gov/books/NBK554567/, (https://www.ncbi.nlm.nih.gov/books/NBK554567/), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879515/, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879515/), https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis, (https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis), https://www.ncbi.nlm.nih.gov/books/NBK534214/, (https://www.ncbi.nlm.nih.gov/books/NBK534214/), Heart, Vascular & Thoracic Institute (Miller Family).

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