Can ultrasound monitor the size of the ascending aorta?

From the Guidelines

Yes, ultrasound can effectively monitor the size of the ascending aorta, with transthoracic echocardiography (TTE) being recommended at diagnosis to assess aortic valve anatomy and function, aortic root, and ascending aorta diameters 1.

Key Points for Monitoring Ascending Aorta Size

• TTE is a non-invasive procedure that does not use radiation and provides real-time images of the aorta.
• The parasternal long-axis view typically offers the best visualization for monitoring the ascending aorta.
• Measurements are usually taken at specific landmarks such as the aortic annulus, sinuses of Valsalva, sinotubular junction, and the tubular ascending aorta.
• The normal ascending aorta diameter is generally less than 4 cm in adults, with gradual enlargement considered normal with aging.
• Regular monitoring is particularly important for patients with aortic dilation, genetic disorders like Marfan syndrome, bicuspid aortic valve, or family history of aortic dissection.

Recommendations for Surveillance

• TTE is recommended at diagnosis to assess aortic valve anatomy and function, aortic root, and ascending aorta diameters 1.
• A global aortic evaluation using all echocardiographic views is also recommended.
• Cardiovascular magnetic resonance (CMR) or cardiovascular computed tomography (CCT) is recommended for surveillance of patients with aneurysm at the distal ascending aorta, aortic arch, or descending thoracic aorta.
• Follow-up imaging with TTE, CCT, or CMR should be considered annually if there is no expansion/extension or customized according to baseline aortic diameter and the underlying condition 1.

From the Research

Ultrasound Monitoring for Ascending Aorta

• Ultrasound can be used to monitor the size of the ascending aorta, as stated in the study 2.
• The study 2 mentions that ultrasound is highly useful in the diagnosis and follow-up of proximal ascending aorta aneurysms.
• However, the study 3 notes that measurement of aortic diameters is more accurate with 3D-CT/MRI compared to ultrasound.

Limitations and Alternatives

• The study 2 highlights the limitations of ultrasound in assessing the ascending aorta, stating that other imaging modalities may be required to confirm measurements and add information on adjacent structures or the involvement of aortic branches.
• Alternative imaging modalities such as CT and MRI are discussed in the studies 2, 4, and 3, which may provide more accurate and detailed information about the ascending aorta.
• The study 5 demonstrates the use of MRI to assess changes in aortic distensibility and pulse wave velocity in patients with Marfan syndrome.

Clinical Applications

• The study 4 provides insight into the clinical application of imaging modalities, including ultrasound, in monitoring patients with aortic enlargement and dissection.
• The study 6 discusses the importance of surveillance imaging in patients with Marfan syndrome, highlighting the role of CT and MRI in monitoring the aorta after surgical repair.
• The study 3 emphasizes the importance of accurate imaging strategies in patients with abdominal aortic aneurysms, including the use of ultrasound, CT, and MRI.