Spontaneous rupture of the ascending aorta—size may not
Harold L. Lazar MD
Division of Cardiac Surgery, Boston University School of Medicine, Boston, Massachusetts
Harold L. Lazar MD, Division of Cardiac Surgery, Boston University School of Medicine, 80 East Concord Street, Boston, MA 02118.
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.
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
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 multidisci-
plinary 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.
1. Mahmood SUB, Ulrich A, Safdar B, et al. Spontaneous rupture of the
ascending aorta. J Card Surg. 2018;33:107–114.
2. Booher AM, Eagle KA. Diagnosis and management issues in thoracic
aortic aneurysm. Am Heart J. 2011;162:38–46.
3. 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,
How to cite this article: Lazar HL. Spontaneous rupture of
the ascending aorta—size may not matter. J Card Surg.
J Card Surg. 2018;33:115. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc.