[Aneurysms of the ascending thoracic aorta]

Aneurysms of the ascending aorta carry a high risk of aortic dissection or rupture in the absence of surgical treatment. Aneurysms of the ascending aorta are classified into 2 distinct types according to their etiology and surgical treatment: aortic root aneurysms, in which the dilatation of the aorta involves the initial portion of the aorta and includes the sinuses of Valsalva and supravalvular aortic aneurysms, which involve the ascending thoracic aorta above the sinuses of Valsalva. Echocardiography and CT scan are the main exams in the evaluation of the diameter of the ascending aorta and its follow up. Conservative treatment by par ss-blockers and follow up by echocardiography once or twice a year is recommended for asymptomatic patients. ss-blockers have demonstrated a slowing effect on dilatation of the aortic root and improve survival especially in patients with Marfan's syndrome. Beyond 50mm, an aneurysm is at risk for complications. Supravalvular aortic aneurysms can be treated by a simple supracoronary tube graft unlike aortic root aneurysms in which replacement or repair of the aortic valve is often necessary. A family history and investigation of other members is essential in patients with aortic aneurysms.