Eur J Cardiothorac Surg 2007;31:331-332. doi:10.1016/j.ejcts.2006.11.006
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
When should we replace the ascending aorta in Marfan syndrome?
Mehmet Ates*
Department of Cardiovascular Surgery, Prof. Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
Received 29 September 2006;
accepted 6 November 2006.
* Corresponding author. Address: Merdivenkoy Mah., Sairarsi Cad., Emincinarpasa Sok., No: 6/24 Goztepe-Kadikoy, 34732 Istanbul, Turkey. Tel.: +90 216 360 0272; fax: +90 216 337 9719. (Email: drmates{at}yahoo.com).
Key Words: Chronic aortic dissection • Marfan syndrome • Aortic surgery
I read with interest the article entitled ‘Chronic dissection of the ascending aorta: surgical results during a 20-year period (previous surgery excluded)’by Jault et al. [1]. They have analyzed the surgical aspects of aortic disease in a 20-year period. I congratulate them for this article and would like to add few comments. Replacement of the ascending aorta is the most frequently performed procedure for thoracic aortic pathology. Current indications for replacement of the ascending aorta and aortic root may be divided into two broad categories: mandatory indications and elective indications. Mandatory indications are usually urgent situations involving acute dissection of the ascending aorta and related pathology. Elective indications are relative indications, as these operations are generally prophylactic in nature, aiming to prevent progression of aortic insufficiency and rupture or dissection of the aorta in Marfan's syndrome related pathology in the presence of degenerative dilatation of the ascending aorta [2]. Our question is when we should replace the ascending aorta in Marfan syndrome. The classical attitudes are as follows: for degenerative aneurysms, 6 cm; for non-Marfan annulo-aortic ectasia, 5.5 cm and for Marfan patients, 5 cm [3]. Recently these diameters are decreased by cardiac surgeons as follows: for degenerative aneurysm; 5 cm and for Marfan patients; 4.5 cm [4]. Legget et al. [5] showed that in Marfan's syndrome, an initial aortic ratio (measured diameter/predicted diameter) at the sinuses of 1.3 increased the relative risk of rupture, dissection or operation for enlarged diameter by 2.7, and a >5% annual increase in the aortic ratio increased these risks by a factor of 4.1. They suggest that patients with dimensions smaller than these parameters could be observed with some degree of comfort. In our institute, if aortic diameter is more than 4.5 cm, we are replacing the ascending aorta in Marfan syndrome and also if it is possible, we are saving aortic valve.
References
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- Legget ME, Unger TA, O'Sullivan CK, Zwink TR, Bennett RL, Byers PH, Otto CM. Aortic root complications in Marfan's syndrome: identification of a lower risk group. Heart 1996;75:389-395.[Abstract/Free Full Text]
