Thoracic Aortic Disease

Question 1

How do you measure the diameter of an aorta?

Answer 1

Measure in all 3 axis, axial, sagittal and coronal

Question 2

How do echo diameters compare to CT diameters?

Answer 2

Echo often underestimates the diameter by 1-2mm

Axial diameter often overestimates

Question 3

To measure the aorta, do you use TTE or TEE?

Answer 3

TTE, there is no role for TEE in surveillance except in dissected aortas for intra-operative repairability

Question 4

What is the risk of rupture of moderately dilated AAo 40-55mm

Answer 4

0.1% per year, so low risk

Question 5

What is the risk of death or stroke from root replacement vs total arch replacement vs TAAAR

Answer 5

1-2% in root replacement vs 5% in total arch replacement vs 5-10% in TAAAR

Question 6

What should be ordered in inflammatory aortic disease?

Answer 6

Medical treatment in most patients, consultation to rheumatology
Wait until inflammatory markers come down
If need to operate due to symptoms, give high dose steroids for several days before operation
Post-operatively needs steroids and DMARDs