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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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The thoracic section of the aorta begins at the T5 vertebra and extends to the T12 level at the diaphragm, initially progressing through the mediastinum to the left of the spinal column. Throughout its course in the thoracic segment, the thoracic aorta emits various offshoots known collectively as visceral and parietal branches. The branches that predominantly supply blood to visceral organs are termed visceral branches and include bronchial, pericardial, esophageal, and mediastinal arteries,...
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Ascending Aorta Dissection Before 5.5 cm Diameter; "It Wasn't Raining When Noah Built the Ark".

Nikolaos A Papakonstantinou1, Filippos-Paschalis Rorris2, Constantine N Antonopoulos3

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Heart, Lung & Circulation
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Acute aortic dissection in non-syndromic patients occurred at a smaller diameter than the 5.5 cm surgical threshold. This suggests current guidelines may need revision for earlier intervention and prevention of thoracic aortic aneurysms.

Keywords:
Aortic diameterAortic dissectionAscending aortic aneurysmsSurgical threshold

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Aortic Dissection

Background:

  • Current guidelines recommend elective ascending aortic repair for non-syndromic thoracic aortic aneurysms at a diameter of 5.5 cm.
  • The optimal diameter threshold for intervention in acute aortic dissection remains a subject of investigation.

Purpose of the Study:

  • To compare the mean maximum ascending aortic diameter at the time of acute aortic dissection with the established surgical threshold for elective repair.
  • To evaluate the potential benefits of adjusting the current diameter-based surgical threshold.

Main Methods:

  • Prospective enrollment of 31 adult patients with non-syndromic acute type A aortic dissection.
  • Measurement of maximum aortic diameter at dissection and comparison with the 5.5 cm elective repair threshold.
  • Assessment of secondary endpoints including mortality, aortic length, and Euroscore II.

Main Results:

  • Mean maximum aortic diameter at dissection was 5.13 cm, significantly lower than the 5.5 cm threshold (p=0.004).
  • Mean aortic length was significantly greater than normal controls (p<0.001), with a length/height ratio of 6.18 cm/m.
  • 30-day/in-hospital mortality was 35.5%, and actual preoperative Euroscore II was significantly higher than predicted for elective repair.

Conclusions:

  • The maximum aortic diameter at acute type A aortic dissection in non-syndromic cases is significantly below the current 5.5 cm threshold for elective repair.
  • Lowering the diameter-based threshold may improve prevention, but further research is warranted.
  • Length-based thresholds could potentially aid in the timely prevention of aortic dissection.