Thoracic Aortic Aneurysm: Reading the Enemy???s Playbook

Abstract

Thoracic aortic aneurysm is a virulent disease which can rupture or dissect and thus hurt or kill our patients. Surgery can prevent rupture, but with inherent surgical risks, which include death, stroke, and paralysis. In order to know if operation is warranted, one must know how likely it is that rupture or dissection will occur for a given sized aorta. Based on scientific data, available todate, we recommend pre-emptive surgery of the aneurysmal ascending aorta at a diameter of 5.5 cm in order to avoid rupture or dissection in most patients, without exposing them unduly or prematurely to the dangers of aortic surgery. We recommend operating earlier, at an aortic dimension of about 5 cm, rather than the 5.5 cm, in patients with Marfan’s disease or other family history of aortic diseases, as they can dissect unpredictably, at relatively smaller diameters. Aortic aneurysm is a genetic disease. As we clarify the genetics of this disease further, we hope to be able to test family member genomes to ascertain if they are afflicted. With genetic understanding will come, in the long term, the potential for specific genetic therapies to correct the underlying causative mutations.