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ȣ - 550427 224 |
Aortic Diameter Predicts Acute Type A Aortic Dissection in Marfan Patients but not in Non-Marfan Patients |
성균관 의대 삼성 서울병원 심장혈관센터 심혈관이미징센터 순환기내과¹ , 흉부외과² , 영상의학과³ ,메이오 클리닉 순환기내과 ⁴ |
김은경¹ , 고성민¹ , 장신이¹ , 최승혁¹ , 성기익² , 김욱성² , 최연현³ , 오재건¹ ⁴, 김덕경¹ |
Objectives: The aim of this study was to assess the feasibility of aortic diameter as a current criterion for elective aortic surgery to prevent the development of aortic dissection in non-Marfan and Marfan (MFS) patients.
Background: Among the parameters considered during watchful follow-up for the genesis of acute type A aortic dissection, aortic size has been considered a cardinal factor. Preventive surgery of the aorta in asymptomatic patients on the basis of size alone is still controversial in patient populations lacking risk factors for aortic dissection.
Methods: We reviewed the data for patients diagnosed with acute type A aortic dissection from December 1994 to March 2009 at our institute.
Results: A total of 237 patients who presented with acute type A aortic dissection were enrolled, of which 31 were diagnosed with MFS. The maximal ascending aorta size was 46.7 mm (42.9 mm–51.6 mm) in non-MFS patients and 58.5 mm (43.8 mm–64.9 mm) in MFS patients (p < 0.001). Two-thirds (74.1%) of MFS patients had a maximal aortic root size ≥ 45 mm. However, 86.9% of the 206 non-MFS patients had aortic diameters < 55 mm. Non-MFS patients presenting with an aortic size < 55 mm developed aortic dissection at a younger age and had a higher body mass index than those with aortic sizes ≥ 55 mm.
Conclusion: Aortic diameter is of limited value and is not a critical parameter for aortic dissection in non-MFS patients.
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Table 1. Clinical characteristics and aortic measurements in patients with and without Marfan syndrome
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Non-MFS
(N = 206) |
MFS
(N = 31) |
P |
Root
Annulus |
23.8 ± 3.5 |
28.8 ± 6.8 |
< 0.001 |
Sinus of Valsalva |
40.2 ± 6.3 |
58.6 ± 15.5 |
< 0.001 |
Sinotubular junction |
31.7 ± 7.4 |
48.0 ± 13.0 |
< 0.001 |
Tubular ascending aorta |
44.4 (34.3-50.6) |
35.7 (32.8-42.6) |
0.001 |
Aortic arch |
38.2 (34.3-41.0) |
31.1 (27.6-34.1) |
< 0.001 |
Descending aorta
Upper descending aorta |
36.6 (33.5-40.3) |
30.6 (27.5-38.1) |
0.001 |
Mid-descending aorta |
34.1 (31.2-37.2) |
29.5 (26.2-33.2) |
< 0.001 |
Lower descending aorta |
32.5 (29.3-35.0) |
26.6 (23.4-30.8) |
< 0.001 |
Abdominal aorta |
29.1 (26.7-31.9) |
26.5 (23.6-30.0) |
0.006 |
Maximal diameter of
the ascending aorta |
46.7 (42.9-51.6) |
58.5 (43.8-64.9) |
< 0.001 |
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