Thoracic aortic aneurysm resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords: ==Overview==

• 60% of thoracic AAs occur in the aortic root and/or the ascending aorta
• 40% occur in the descending aorta
• 10% occur in the aortic arch, and 10% occur in the thoracoabdominal aorta.

• high blood pressure, especially not controlled, dyslipidemia, smoking, use of cocaine and other stimulants which increase aortic wall stress, weight lifting, trauma, aortic coarctation, pheochromocytoma, and disorders with abnormalities of the aortic media increased risk of aortic dissection, pregnancy, polycystic renal disease, chronic use of corticosteroids or immunosuppressant drugs, and aortic wall infections increase risk of aortic dissection in patients with thoracic aneurysm.

• patients with thoracic AA must be counseled about smoking cessation.
• Dyslipidemia must be treated. Atorvastatin 40 to 80 mg daily or rosuvastatin 20 to 40 mg daily should be administered
• Hypertension must be controlled with beta-blocker plus an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker these in these patients. The blood pressure in persons with thoracic AA should be lowered to less than 130/80 mmHg.
• If there are symptoms suggesting thoracic AA expansion, surgical intervention should be considered.
• If the ascending thoracic aorta or aortic sinus diameter is 5.5 cm or more in an asymptomatic surgical candidate who has a degenerative thoracic AA, chronic aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, mycotic aneurysm, or pseudoaneurysm, surgery should be performed.
• Asymptomatic persons with genetic conditions such as Marfan's syndromes should have elective surgery if their diameters are 4.0 to 5.0 cm depending on the disorder to prevent acute dissection or rupture.
• Asymptomatic persons with Marfan’s syndrome should be treated with surgical intervention if their ascending thoracic aortic diameter is 5.0 cm or more and with <5.0 cm if there is a family history of dissection or an increase in ascending thoracic aortic diameter greater than 0.5 cm per year.
• Asymptomatic persons who have Loeys-Dietz syndrome should be treated with surgical intervention if their ascending thoracic aortic diameter is ≥4.2 cm by transesophageal echocardiography or 4.4 to

4.6 cm by cardiac computed tomography or cardiac magnetic resonance

• If the increase in the ascending thoracic aortic diameter is greater than 0.5 cm per year in an asymptomatic person with a diameter below 5.5 cm, surgical intervention should be performed.
• Asymptomatic persons with bicuspid aortic valve should have surgical intervention if the diameter of their aortic sinuses or ascending thoracic aorta is >5.5 or >5.0 cm with a family history of aortic dissection or an increase in diameter ≥0.5 cm/year
• The ascending thoracic aorta should be replaced in persons with bicuspid aortic valve having aortic valve surgery if their ascending thoracic aorta diameter is >4.5 cm

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.