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The clinical spectrum of patients with aneurysms of the ascending aorta
M J Eisenberg1, S A Rice, A Paraschos
1Cardiovascular Research Institute, John Henry Mills Echocardiography Laboratory, University of California, San Francisco.
Insights
Aneurysms of the ascending aorta are often undetected but dangerous. Early imaging is crucial for patients with Marfan syndrome or atherosclerosis, especially if aortic insufficiency is present.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Aneurysms of the ascending aorta pose a significant risk of rupture or dissection.
- Early detection and understanding of their clinical spectrum are vital for patient outcomes.
Observation:
- A 7-year review identified 15 patients with ascending aorta aneurysms (≥ 5.0 cm).
- Younger patients (<50) often had Marfan syndrome, while older patients (≥50) showed atherosclerotic disease.
- Most patients presented with nonspecific symptoms; echocardiography revealed aortic insufficiency in 12 and dissections in 5.
Findings:
- Ascending aorta aneurysms present a wide clinical spectrum.
- Aneurysm size varied, with larger diameters (>7.0 cm) in some patients.
- Mortality was observed in both surgically treated and medically managed patients within a week of presentation.
Implications:
- Physicians should consider imaging the ascending aorta in at-risk populations.
- A low threshold for imaging is recommended for patients with Marfan syndrome or atherosclerosis.
- Prompt diagnosis and management are critical due to the high risk of catastrophic events.
Abstract:
Aneurysms of the ascending aorta are often unsuspected, yet they can quickly lead to death from aortic rupture or dissection. To examine the clinical spectrum of patients with aneurysms of the ascending aorta, we searched the University of California, San Francisco (USCF) Echocardiography Data Base for all patients with aneurysms of the ascending aorta (> or = 5.0 cm in diameter) seen over a 7-year period. The echocardiograms and clinical courses of these patients were then reviewed. We identified 15 patients with aneurysms of the ascending aorta: five had aneurysms > 7.0 cm in diameter, three had aneurysms 6.0 to 6.9 cm, and seven had aneurysms 5.0 to 5.9 cm in diameter. Among the five patients < 50 years of age, four had Marfan's syndrome, and among the 10 patients > or = 50 years of age, eight had evidence of atherosclerotic vascular disease. At presentation, 13 patients had nonspecific symptoms, and two were asymptomatic. Echocardiography demonstrated that 12 patients had at least mild aortic insufficiency and that five had aortic dissections. One of the seven patients who underwent surgical resection died of an intraoperative cardiac arrest, and two of the eight patients treated medically died within 1 week of presentation. We conclude that the clinical spectrum of patients with aneurysms of the ascending aorta is wide. Because these aneurysms are often unsuspected, physicians should have a low threshold for imaging the ascending aorta in patients with Marfan's syndrome or atherosclerotic vascular disease, particularly when aortic insufficiency is present.