Different clinical course of ascending aortic aneurysm in monozygotic twins

A 45-year-old woman without medical history of cardiovascular disease came to the clinic. She was diagnosed as annuloectasia and aneurysm of ascending aorta and dissected aorta from above the aortic valve to renal artery level (type A). There are no laboratory abnormalities including CBC, biochemistry, and serology tests etc. She does not have any Marfanoid features. Surprisingly, when we reviewed her family history, we realized her monozygotic twin sister performed Bentall operation because of grade III/IV of aortic regurgitation due to annuloectasia and aneurysm of ascending aorta in our hospital 2 years ago. Now she underwent modified Bentall operation and recovered well. Our case suggests that physicians should meticulously check-up the first-order relatives of probands before dissection happens because familial thoracic aortic aneurysms tend to grow at a higher rate.