Aortic size in acute type A dissection: implications for preventive ascending aortic replacement.

Publication/Presentation Date

6-1-2009

Abstract

OBJECTIVE: Elective ascending aortic replacement is recommended to prevent acute type A aortic dissection when any segment of the proximal aorta is greater than 5.5 cm. However, little data exist that meticulously describe the size of the ascending aorta at multiple levels in patients who suffer acute type A dissections. We sought to definitively characterize the size distribution of the proximal aorta in this patient population.

METHODS: Preoperative transesophageal echocardiography was used to measure the diameter of the proximal aorta at the aortic annulus, in the sinus segment, at the sinotubular junction and in the ascending aorta in 177 non-Marfan patients with tricuspid aortic valves who presented to one institution over a 10-year period with an acute type A dissection. Predicted aortic diameters for each patient based on the individual's age, gender and body size were also calculated at all four aortic positions using previously published regression equations derived from a large cohort of normal patients.

RESULTS: Sixty patients were female (33.9%; aged 67+/-12 years) and 117 were male (66.1%; aged 60+/-17 years). Sixty-two percent of all patients had maximum aortic diameters less than 5.5 cm at time of dissection and 42% of patients had maximum aortic diameters less than 5.0 cm. Over 20% of all patients had maximal aortic dimensions of less than 4.5 cm. In women, 12% of the dissected aortas had a maximal dimension less than 4.0 cm.

CONCLUSIONS: The majority of patients with acute type A aortic dissection present with aortic diameters

Volume

35

Issue

6

First Page

941

Last Page

945

ISSN

1873-734X

Disciplines

Medicine and Health Sciences

PubMedID

19237295

Department(s)

Department of Surgery

Document Type

Article

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