Ascending Aortic Aneurysm

The aorta is the largest artery in the human body. It emerges from the heart, receives the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood ejected by the left ventricle, and distributes it throughout the body—much like the trunk of a tree sending sap out to its branches.

A Brief Anatomy Lesson

It is divided into three main parts:

Ascending aorta (A): This initial section starts at the heart and rises toward the main vessels that supply the brain and arms.
Thoracic aorta (B): From this branching point, it continues downward through the diaphragm, the main respiratory muscle.
Abdominal aorta (C): Exiting the thoracic cavity, it travels deep into the abdomen, where it divides into two branches forming an inverted Y, giving rise to the iliac arteries.

Normal Size

From one segment to the next, the aorta tends to decrease in diameter as it moves away from the heart. It is normal for this large vessel to undergo slight dilation with age. However, the diameter of the ascending aorta should not exceed 4 centimeters—or about 1.5 inches.

Beyond this size, we refer to it as an ascending aortic aneurysm, a condition that can pose serious health risks and requires close medical follow-up.

Possible Causes

Aortic dilation can result from several causes. Among the most common are:

high bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure,
certain genetic diseases such as Marfan syndrome, and other inherited disorders affecting the aorta,
infections,
inflammation,
or more rarely, chest trauma, can also be contributing factors.

A Often Accidental Discovery

In the vast majority of cases, this condition is asymptomatic and goes unnoticed. It is often detected by chance during a chest CT scan or a cardiac ultrasound performed for an entirely different medical reason.

From Aneurysm to Tear

Ascending aortic dissection is an extremely serious medical emergency. It occurs when a tear forms in the inner layers of the wall of this large artery, allowing bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood to seep in and separate the different layers of the vessel wall.

This internal tear can lead to the complete rupture of the aorta—a frequently catastrophic event with a very high risk of death.

Fortunately, this complication is rare. But when it does occur, the consequences are often dramatic: about half of affected individuals die before even reaching the hospital. And once the dissection begins, the risk of death increases by approximately 1% per minute without emergency treatment.

This reality underscores the importance of early detection, close monitoring of known aortic dilations, and preventive intervention before the aorta reaches a critical size.

How to Monitor It

Medical imaging is essential not only to make the diagnosis but also to monitor ascending aortic aneurysms over time.

Several techniques can be used to visualize this part of the heart, including:
echocardiography,
computed tomography (also known as CT scan),
magnetic resonance imaging (MRI).

These exams help measure the size, observe the shape, and monitor the evolution of the aneurysm over time.

Follow-Up

When an aneurysm is small (generally less than 5 cm in diameter for the ascending aorta), regular imaging follow-up is often recommended instead of immediate surgery.

This monitoring helps detect any abnormal growth that might require intervention. The frequency of these exams will depend on the initial size of the aneurysm and the physician’s judgment.

Some Precautions

Monitor bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure

Keeping bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure well controlled is important to prevent the aneurysm from growing. Medications may be prescribed to reduce pressure and thus lessen the stress on the aortic wall.

Stay active, but avoid overexertion

Exercise is beneficial, but certain efforts should be avoided. Regular endurance activities like walking or leisurely cycling are recommended, while intense or strenuous efforts—such as heavy lifting, bodybuilding, or high-intensity interval training—should be avoided.

Consider heredity

When aneurysms are present in the family, a genetic evaluation may be warranted. The goal is to determine whether a hereditary factor is involved, sometimes linked to a gene passed down from one parent to another.

Treatment

The decision to intervene on an aortic aneurysm depends on several factors:
the size of the dilation, its location, how quickly it is growing, and the patient’s characteristics (height, weight, overall health, lifestyle, occupation, and medical history).

For the repair of an ascending thoracic aortic aneurysm, only one approach is possible:

Open surgery, which involves opening the chest

Open Surgery

This is a major procedure in which the surgeon replaces the dilated portion of the aorta with a synthetic tube, often made of Dacron.

Risk

In non-emergency situations, the surgical risk is usually below 5%.

However, in emergencies—such as a tear or rupture—the risk increases significantly and can reach 15 to 20%.

Consent Form

Before undergoing open surgery to repair an ascending aortic aneurysm, an informed consent form must be signed.

This document confirms that the individual has received complete information about the purpose of the procedure, the expected benefits, the possible risks, and the available treatment options.

In most cases, these aspects have been discussed during preoperative consultations, and all questions have been addressed prior to signing the consent.

Postoperative Follow-Up

After surgical or endovascular intervention on the aorta, regular medical follow-up is essential. Medical imaging (such as CT scans or MRI) is used to monitor the condition of the rest of the aorta, detect any potential complications, and adjust treatment if necessary.

In some cases, another procedure may be considered if other segments of the aorta become dilated over time.

Once recovery is underway, the individual can gradually resume their usual activities. Restrictions on physical activity are generally lifted, but it is important to do so under supervision and without overexertion.

The intensity and type of exercise should be discussed with the care team, based on the patient’s overall condition and any recommendations specific to their case.

In Conclusion

When an ascending aortic aneurysm is discovered—often incidentally—the main goal becomes preventing rupture or tearing, which can have serious or even fatal consequences.

The real challenge is determining the right moment to intervene: when the benefits of surgery outweigh the risks of inaction. Careful follow-up and a personalized approach help anticipate this decision and act before complications arise.