From the Guidelines
For a 76-year-old male with a mildly dilated aortic root and ascending aorta that has remained stable over 6 months, the recommended follow-up includes surveillance imaging every 6 to 24 months, as appropriate based on individual anatomy, to determine the rate of aortic enlargement and monitor for progression 1. The choice of imaging modality, such as TTE, CT, or MRI, should be based on individual anatomy and the ability to provide clear images of the aortic root and ascending aorta.
- Key considerations for follow-up include:
- The rate of aortic growth
- The proximity of the aortic diameter to the surgical threshold
- The patient's age
- The underlying cause of the aortic dilation According to the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease, a detailed baseline assessment of all segments of the thoracic aorta, aortic valve anatomy, and aortic valve function is important, and can be achieved with TTE, CT, or MRI 1.
- Blood pressure control is essential, with a target of less than 130/80 mmHg, and can be achieved with medications such as beta-blockers or angiotensin receptor blockers, which may help slow aortic dilation.
- Lifestyle modifications, including smoking cessation, moderate aerobic exercise, and limiting caffeine intake, are also important to reduce the risk of aortic complications. The patient should be advised to report any new chest or back pain immediately, and surgical intervention would be considered if the aorta reaches 5.0-5.5 cm in diameter or shows rapid growth (>0.5 cm/year) 1.
From the Research
Recommendations for a 76-year-old male with a mildly dilated aortic root and ascending aorta
- The patient's echocardiogram shows a mildly dilated aortic root and ascending aorta, with no change in findings after 6 months 2.
- According to the study by 3, separate ascending aorta and aortic valve replacement is not associated with subsequent aortic root dilation on medium-term echocardiography follow-up.
- Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases, and can be used to assess aortic size, biophysical properties, and atherosclerotic involvement of the thoracic aorta 4.
- The use of angiotensin receptor blockers (ARBs) has been shown to slow down the progression of aortic dilatation in patients with Marfan syndrome 5.
- Medical prophylaxis with losartan or atenolol has been shown to reduce proximal aortic growth rates in young patients with bicuspid aortic valve and dilated aorta 6.
- The patient's treatment plan should be individualized, taking into account their age, medical history, and the severity of their aortic dilation.
- Regular follow-up echocardiograms should be performed to monitor the patient's aortic diameter and assess for any changes or progression of their condition 2, 3, 4.