Ascending Aortic Aneurysm

Introduction

An ascending aortic aneurysm occurs when the aortic wall becomes weakened and enlarges. Many causes exist including atherosclerosis, hypertension and connective tissue disorders.

There are no specific symptoms related to an ascending aortic aneurysm until a complication occurs. In large ascending aortic aneurysm, the recurrent laryngeal nerve can be compressed causing a hoarse voice.

Physical examination is non-specific, however in large aneurysm, suprasternal pulsations may be palpable. The fatal complication of an ascending aortic aneurysm is rupture and/or aortic dissection.

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Ascending aortic aneurysm before and after repair

Diagnosis

The diagnosis of an ascending aortic aneurysm is best made on CT angiography or MR angiography. Echocardiography can visualized the proximal portion of the aorta, however not the aortic arch and only minimal portions of the descending thoracic aorta. Transesophageal echocardiography is also accurate and can visualized the entire thoracic aorta. This is the preferred method if chronic kidney disease prohibits the use of contrast imaging with CT or MRI.

Treatment

Strict blood pressure control can help prevent progression of the aneurysm in many patients. This is frequently achieved with beta-blockers. When the aneurysm reaches greater than 5.5 cm in normal individuals, surgical repair is recommended. If the aneurysm is > 5.0 cm and there is a connective tissue disorder present (Marfan’s syndrome, bicuspid aortic valve etc...), then surgical repair is indicated.