Aorta Flashcards
Degenerative ascending aortic aneurysm surveillance
- 5-4.5 cm annual
4. 5-5.4 cm biannual
Genetic TAA surveillance
- 5-4.0 annual
4. 0-5.0 biannual
Descending aorta aneurysm surveillance
- 0-5.0 annual (CT/MRA)
5. 0-6.0 biannual (CT/MRA)
TAA indications for repair
Symptoms or rupture Size Rapid enlargement Traumatic Infectious AVR if ascending aorta > 4.5
Size for repair for ascending TAA
Diameter > 5.5 cm or index >= 2.75
>4.5 cm genetic
Size for repair for descending TAA
> 5.5 cm
>5.0 cm genetic
TAA rapid enlargement
> = 10 mm/yr
>5 mm/yr in genetic
Indication for repair for AAA
Symptoms rupture > 5.5 cm Rapid expansion Inflammatory or infectious
Screening for AAA
Men 65-75 who smoked
Men >= 60 with 1st deg relative with AAA
Complex plaque in aorta
Increased risk of embolism
>4 mm width
Mobile at any size
Ulcerated
Penetrating aortic ulcer
Similar to dissection
Echolucent intramural hematoma overlying atherosclerosis
Increase wall thickness
No intimal flap
Aortic intramural hematoma
Similar to dissection
No intimal tear
Layered thickened, crescentic hematoma
BAV cut off for surgery
55 mm
BAV higher risk features
50 mm FH of dissection >3 mm/year dilatation Uncontrolled HTN Root phenotype Coarctation
Marfan surgery cutoff
50 mm
Ascending aorta measurement in kids
Inner edge to inner edge in systole
Ascending aorta measurement in adults
Leading edge to leading edge end-diastolic
Bovine aortic arch
Innominate artery and left common carotid artery have a common origin
9-13% of individuals
Imaged from suprasternal notch
Complex aortic atheroma most likely to occur in
Descending aorta
Traumatic aortic deceleration injury most common finding
Localized thick flap in region of aortic isthmus
Aortic aneurysm definition
Aortic dilatation to at least 1.5x expected normal diameter
Marfan aorta
Aneurysm of ascending aorta involving at least the sinuses of valsalva (most common site)
Descending thoracic and thorax-abdominal aorta are also common
Mirror image right sided aortic arches
Innominate artery originates as first branch, then right carotid, then right subclavian
A/w ToF
Non-mirror image R sided aortic arch
Left carotid artery, right carotid artery, right subclavian, left subclavian
Left subclavian originates from proximal descending aorta with prominent diverticulum of Kommerall
Shone complex
Supravalvular mitral ring
Parachute-like mitral valve
Subaortic stenosis
Aortic coarctation
Turner syndrome a/w
Coarctation
BAV
Aneurysm / dissection
Noonan syndrome a/w
Pulmonary stenosis
HCM
BAV associated with
Ascending aortic dilatation in >50%
Most often tubular ascending aorta
Coarctation ~5%
DeBakey 1
Ascending aorta, arch +/- descending
DeBakey II
ascending aorta only
DeBakey IIIa
Descending aorta above diaphragm
Debakey IIIb
Descending aorta below diaphragm
Grade 1 aortic atheroma
Thickness <2mm
Normal intimal thickening
Grade II atheroma
Mild intimal thickening 2-3 mm
Grade III atheroma
Moderate intimal thickening
>3-5 mm
Grade IV atheroma
Severe thickening
>5mm
Grade V atheroma
Complex atheroma
Grade 2-4 + mobile or ulcerated components
Aortic doppler in coaractation
Typically overestimates peak gradient due to elevated pre-coaractation velocity
Quadricuspid AV associated with
Severe AR
Not aortic conditions
Best view for ascending aorta
Parasternal window
Move up an interspace, medial toward sternum
Hemodynamically significant PDA
Left sided volume overload
Pulmonary hypertension
Abdominal aorta doppler coarctation
Low velocity systolic velocity
Higher-velocity diastolic forward flow
Decreased pulsatility
Delay in systolic peak velocity
Thickening of aortic-mitral curtain
Aortitis
Endocarditis with abscess
