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The Troika of Aortopathy: Size, Function and Etiology

aortic diameter is 4.0–4.4 cm compared to a smaller aorta size (<3.4 cm) and increases substantially when the diameter of the aorta is more than 4.5 cm. The authors conclude that an aorta size of 5.0–5.5 cm used today for prophylactic aortic surgery is still valid. Although dissections can occur in aortas with smaller diameters, the relative risk of dissection compared to the large numbers of patients with smaller aortas is extremely low. Performing surgery in patients with a smaller aorta who have a minimal risk of dissection exposes individuals to the small, but real risk of open heart surgery [3] . Careful observation, however, is recommended when the aorta reaches a diameter of 4.5 cm. This is an important study that provides fundamental information related to the size of the aorta in the general population using magnetic resonance imaging. Furthermore, this study provides strong evidence supporting the current practice related to interventional therapy in patients with aortic dilatation. Due to the nature of the study, there is no information related to changes of the aortic diameter over time. Information related to this topic is generally limited. In most instances of acute aortic dissection, the only size of the aorta available is at the time of dissection. In a recent study in a small number of patients with aortic dissection who underwent computed tomography imaging prior to dissection, it was found that the average size of the ascending aorta 2 years prior to dissection was 3.4 cm, while at the time of dissection it was 5.2 cm. It is not known, Introduction