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In 4 patients with aortic stenosis and regurgitation, progressive dilatation of the ascending aorta and dissecting aneurysm developed. Cystic medial necrosis was discovered histologically. It is suggested that the change in the aorta is secondary to hemodynamic stresses imposed by the disease at the aortic valve.IN 4 patients we have observed the association of aortic stenosis with large fusiform and dissecting aneurysm in the ascending aorta. In each case Erdheim's cystic medial necrosis was present. It is our purpose, in describing these cases, to suggest that the association is more than coincidence. mal to the innominate ostium, beyond which point the aorta seemed to be of normal caliber. There was a mass of fibrin and fibrous tissue suggesting previous inflammation on the anterior surface of the ascending aorta. The ascending aorta was mobilized and almost half its circumference was excised. In this process it became apparent that there was a dissection in the wall of the ascending aorta. A finger was introduced into the aorta through a diverticulum sutured to the aorta, and the aortic valve was palpated. The right anterior commissure was fused and the 2 cusps adjacent to it constituted almost a single large cusp. Calcified, rigid areas were felt. The other 2 commissures were free; the tip of the finger could be fitted through the orifice and, in general, the stenosis was not thought to be of high grade. Finger-fracture of the aortic valve was not attempted for fear of aggravating the hemodynamic disturbance at that site. The ascending portion of the aorta was wrapped in a Nylon scultetus binder.* At the close of the procedure the ascending portion of the aorta was uniformly 12 to 13 em. in circumference.Histologic study of the removed aortic tissue showed cystic medial necrosis.* Surgical features of this and the following case have been described elsewhere' and illustrated by means of chest x-rays and artist 's sketches of the findings at operation.

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