The clinical spectrum of patients with aneurysms of the ascending aorta

Aneurysms of the ascending aorta are often unsuspected, yet they can quickly lead to death from aortic rupture or dissection. To examine the clinical spectrum of patients with aneurysms of the ascending aorta, we searched the University of California, San Francisco (UCSF) Echocardiography Data Base for all patients with aneurysms of the ascending aorta (≥5.0 cm in diameter) seen over a 7-year period. The echocardiograms and clinical courses of these patients were then reviewed. We identified 15 patients with aneurysms of the ascending aorta: five had aneurysms >7.0 cm in diameter, three had aneurysms 6.0 to 6.9 cm, and seven had aneurysms 5.0 to 5.9 cm in diameter. Among the five patients <50 years of age, four had Marfan's syndrome, and among the 10 patients ≥50 years of age, eight had evidence of atherosclerotic vascular disease. At presentation, 13 patients had nonspecific symptoms, and two were asymptomatic. Echocardiography demonstrated that 12 patients had at least mild aortic insufficiency and that five had aortic dissections. One of the seven patients who underwent surgical resection died of an intraoperative cardiac arrest, and two of the eight patients treated medically died within 1 week of presentation. We conclude that the clinical spectrum of patients with aneurysms of the ascending aorta is wide. Because these aneurysms are often unsuspected, physicians should have a low threshold for imaging the ascending aorta in patients with Marfan's syndrome or atherosclerotic vascular disease, particularly when aortic insufficiency is present.