From the Guidelines
The normal aortic root size is not explicitly defined in the provided evidence, but according to the most recent guideline, aortic diameters vary depending on age, sex, height, and body size, and prophylactic aortic root replacement is reasonable when the maximal cross-sectional area of the aortic root or ascending aorta divided by the patient’s height is ≥10 cm2/m 1.
Aortic Root Size Considerations
When considering the size of the aortic root, it's essential to take into account factors such as age, gender, and body size, as these can influence the normal diameter range.
- The evidence suggests that aortic event rates, including aortic dissection, increase as the aortic size indexed to height (or body size) increases 1.
- While specific normal ranges are not provided in the evidence, the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease provides a framework for evaluating aortic root size based on the cross-sectional area to height ratio 1.
Monitoring and Intervention
For patients with aortic root dilation, regular monitoring with echocardiograms is crucial to assess the progression of dilation and guide management decisions.
- The frequency of monitoring may vary depending on the severity of dilation and individual patient factors, such as the presence of Marfan syndrome, bicuspid aortic valve, or family history of aortic dissection.
- Surgical intervention is generally considered when the aortic root reaches a certain threshold, although this may vary depending on individual patient factors and guidelines from reputable sources such as the European Society of Cardiology (ESC) 1 or the American Heart Association (AHA) 1.
Management and Treatment
Controlling hypertension with medications such as beta-blockers or angiotensin receptor blockers is crucial for patients with aortic root dilation, as these medications can help reduce stress on the aortic wall and potentially slow the progression of aortic dilation.
- The choice of medication and management strategy should be individualized based on patient-specific factors, including the presence of comorbidities and the severity of aortic dilation.
- A multidisciplinary approach, involving cardiologists, cardiothoracic surgeons, and other specialists, may be necessary to optimize management and treatment of patients with aortic root dilation.
From the Research
Aortic Root Size
- The size of the aortic root can be measured using echocardiography or computed tomography (CT) [ 2 ]
- Echocardiography may underestimate the aortic root size compared to CT measurements, with an average difference of 2.5 mm [ 2 ]
- The aortic root diameter can increase over time, with a rate of 0.4 mm/year in patients with Marfan syndrome [ 3 ]
Factors Influencing Aortic Root Size
- Age and hypertension can contribute to stiffening and dilation of the aortic root [ 4 ]
- The left ventricular outflow tract diameter can be used as a reference to predict normal aortic root size [ 5 ]
- Body surface area (BSA) is currently used to predict normal aortic root size, but it may not be the most accurate method [ 5 ]