In this issue of the Journal, Mahmood et al report seven patients, without any known previous aortic or connective tissue disorder, that presented with spontaneous rupture of the ascending aorta. The mean ascending aortic diameter in these patients at the time of rupture was 4.60 ± 0.62 cm, well below the established guidelines for surgical intervention. The most common presentation was chest pain in a patient with a known history of hypertension. Interestingly, 5.7% of the patients presented with stable hemodynamics and one patient had no definitive signs of aortic pathology on computed tomography imaging. Only two patients in this series, with a mean diameter of 4.25 ± cm, were being followed for aortic dilatation. This suggests that other parameters to monitor the risk of aortic rupture, such as the Aortic Height Index, which takes into account the patient's height and not the more complicated body surface area measurement, may be a more reliable measurement of risk prediction for aortic rupture than simply aortic diameter.This study also demonstrates the importance of timely imaging and a high index of suspicion, which is essential to make a prompt diagnosis of this life‐threatening disease. The creation of a multidisciplinary aortic emergency team to triage these patients for the proper imaging studies and expedite their transfer to the operating room has contributed significantly to the outstanding results achieved by this group and should become the standard of care in all institutions dealing with acute aortic pathology.REFERENCESMahmood SUB, Ulrich A, Safdar B, et al. Spontaneous rupture of the ascending aorta. J Card Surg. 2018;33:107–114.Booher AM, Eagle KA. Diagnosis and management issues in thoracic aortic aneurysm. Am Heart J. 2011;162:38–46.Zofar MA, Li Y, Rizzo JA, et al. Height alone (rather than body surface area) suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg. 2018. (in press; https://doi.org/10:1016/J.JTCVS, 2017.10.140).
Journal of Cardiac Surgery – Wiley
Published: Jan 1, 2018
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