Spontaneous rupture of the ascending aorta
Syed Usman Bin Mahmood MBBS
Andrew Ulrich MD
Basmah Safdar MD
Arnar Geirsson MD
Abeel A. Mangi MD, MBA
Section of Cardiac Surgery, Yale University
School of Medicine, New Haven, Connecticut
Section of Emergency Medicine, Yale
University School of Medicine, New Haven,
Abeel A. Mangi MD, MBA, Section of Cardiac
Surgery, Yale School of Medicine, BB204, 330
Cedar Street, New Haven, Connecticut.
Background: Nontraumatic, spontaneous rupture of the ascending aorta is rare and the
etiology is largely unknown.
Methods: We reviewed seven patients from our institution, with no known aortic
disease or hereditary connective tissue disorder that presented with spontaneous
ascending aortic rupture from 2012 to 2017.
Results: Most patients presented with non-radiating chest pain along with hyperten-
sion (71.4%). The mean ascending aortic diameter at rupture was 4.60 ± 0.62 cm. The
median door-to-operating room time was 2.58 h, resulting from effective implementa-
tion of an aortic emergency protocol. There were no operative mortalities.
Conclusions: In patients with ascending aortic rupture, aortic diameter may not always
correlate with the risk of rupture. Rapid diagnosis combined with a multidisciplinary
approach is vital for the successful management of these high-risk patients.
ascending aorta, emergent, rupture
Ascending aortic rupture is generally a sequel of a preexisting
aneurysm that may or may not be associated with a connective tissue
The rate of rupture for untreated thoracic aortic aneurysm
ranges from 21% to 74%.
Spontaneous ascending aortic rupture
occurring without prior aortic or connective tissue disease is a rare
and unpredictable phenomenon with only 40 cases reported in
The aortic diameter does not always correlate with the
risk of rupture in these patients. Aortic dimensions change
throughout life according to gender, segment, and body morphology
that complicates the ability to reliably predict a “point of rupture” for
ascending aortic disease.
Spontaneous ascending aortic rupture is associated with a
mortality rate of 57%.
Time is critical in these patients as any delay
in surgery is a major contributor to morbidity and mortality.
We describe a series of patients who presented to our hospital
with non-traumatic, spontaneous ascending aortic rupture from 2012
to 2017. These cases highlight the importance of timely imaging and a
high index of suspicion to quickly and accurately establish a diagnosis.
They further emphasize the importance of a multidisciplinary aortic
emergency team in expediting the transfer of a confirmed rupture
patient to the operating room (OR) for definitive surgery.
This is a single-center case series based upon retrospective review of
patients who presented consecutively from 2012 to 2017 at the Yale
New Haven Hospital. The study was approved by the Yale HIC and
designated IRB# 2000020356. Patients aged 18 years or older who
had a spontaneous rupture of the ascending aorta with no known
aortic disease were included. Basic demographic data, operative
details, and clinical follow-up until October 2017 were reviewed with
special emphasis on timing of admission, initial emergency department
(ED) screening, diagnostic modalities, and operative management. All
patients underwent emergent surgical management according to the
Yale protocol for diagnosis and management of aortic emergency.
DISEASES OF THE AORTA
J Card Surg. 2018;33:107–114. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc.