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Natural history of moderately dilated tubular ascending aorta: implications for determining the optimal imaging

Kay-Hyun Park, Suryeun Chung, Dong Jung Kim

    European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
    |March 23, 2017
    PubMed

    Insights

    For moderately dilated ascending aortas (35-54 mm), annual imaging may be excessive. A 3-4 year interval is reasonable for stable aortas ≤45 mm, with closer monitoring for larger or worsening conditions.

    Area of Science:

    • Cardiovascular Imaging
    • Aortic Disease Management
    • Radiology

    Background:

    • Current guidelines recommend annual or semi-annual imaging for moderately dilated ascending aortas (35-54 mm).
    • Limited data exist on the actual yield and benefit of these frequent surveillance protocols.
    • Determining optimal imaging intervals is crucial for efficient patient management.

    Purpose of the Study:

    • To investigate the progression of moderately dilated ascending aortas.
    • To establish appropriate imaging intervals for surveillance of ascending aortic dilation.
    • To identify factors associated with aortic growth and adverse events.

    Main Methods:

    • Retrospective analysis of 509 adult patients with ascending aortic diameter ≥40 mm from an institutional database.
    • Comparison of maximal aortic diameter between initial and follow-up contrast-enhanced computed tomography scans (≥1 year interval).
    • Review of medical records for associated illnesses and clinical events.

    Main Results:

    • Mean growth rates were 0.3 mm/year for 40-44 mm, 0.3 mm/year for 45-49 mm, and 0.7 mm/year for ≥50 mm ascending aortas.
    • Significant progression (≥5 mm increase) occurred in 3.4% (40-44 mm), 5.6% (45-49 mm), and 21.7% (≥50 mm) over a mean of 4.3 years.
    • Initial diameter ≥45 mm and aortic valve regurgitation were associated with significant progression; 1% experienced acute type A aortic dissection.

    Conclusions:

    • For ascending aortas ≤45 mm, stable on initial annual follow-up, a 3-4 year imaging interval is suggested.
    • More frequent surveillance is recommended for patients with aortic valve insufficiency or initial diameters ≥45 mm.
    • These findings support personalized imaging strategies for ascending aortic dilation.
    Abstract

    Keywords:
    AneurysmAscending aortaComputed tomography

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