From the Guidelines
An ascending aortic dimension of 37 mm in the anteroposterior (AP) direction is considered mildly dilated but does not require immediate surgical intervention. According to the most recent guidelines, including the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1, regular monitoring with annual imaging (echocardiogram or CT scan) is recommended to track any progression.
Key Recommendations
- Blood pressure control is essential, with a target below 130/80 mmHg using medications such as beta-blockers (e.g., metoprolol 25-100 mg twice daily) or angiotensin receptor blockers (e.g., losartan 50-100 mg daily) 1.
- Lifestyle modifications including smoking cessation, moderate aerobic exercise, and avoiding heavy weightlifting or isometric exercises that cause significant blood pressure spikes are important.
- The threshold for surgical intervention is typically 55 mm for most patients, or 50 mm if there are risk factors like family history of aortic dissection, rapid growth (>3-5 mm/year), or connective tissue disorders, as stated in the 2022 aortic disease guideline-at-a-glance 1 and further supported by the 2024 ESC guidelines 1. This mild dilation occurs because the aortic wall weakens over time due to factors like hypertension, age-related elastin fragmentation, or genetic predisposition, causing the vessel to gradually expand under constant pressure.
Monitoring and Follow-up
- Cardiac MRI or CT is indicated in patients with BAV when the morphology of the aortic root and the ascending aorta cannot be accurately assessed by TTE, as recommended by the 2024 ESC guidelines 1.
- In the case of aortic diameter >50 mm or an increase of >3 mm per year measured by echocardiography, confirmation of the measurement is indicated, using another imaging modality (CT or MRI) 1.
From the Research
Ascending Aortic Dimension
- The given ascending aortic dimension is 37 mm AP.
- According to the provided studies, there is no direct information about the risk associated with an ascending aortic dimension of 37 mm AP.
- However, a study 2 mentions that the risk of aortic adverse events increases with the length of the ascending aorta, but it does not provide specific information about the diameter of 37 mm AP.
Comparison with Study Findings
- A study 3 discusses the results of conservative and replacement strategies for type A acute aortic dissection with an aortic root diameter of ≥40 mm, but it does not provide information about an ascending aortic dimension of 37 mm AP.
- Another study 4 talks about the treatment of a dilated ascending aorta during aortic valve replacement, but it does not specify the diameter of 37 mm AP.
- A case report 5 describes the conservative approach of ascending aortic dissection after transcatheter aortic valve replacement, but it does not provide information about the ascending aortic dimension of 37 mm AP.
Lack of Direct Evidence
- There are no research papers that directly address the risk associated with an ascending aortic dimension of 37 mm AP.
- The provided studies discuss various aspects of aortic disease, but they do not provide specific information about the given ascending aortic dimension.