Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application?

Abstract

Objective: The risk of rupture and dissection in ascending thoracic aortic aneurysms increases as the aortic diameter exceeds 5 cm. This study evaluates the clinical effectiveness of a specific algorithm based on size and symptoms for preemptive surgery to prevent complications.

When should a rare inherited connective tissue disorder be suspected in bicuspid aortic valve by primary-care internists and cardiologists? Proposal of a score

“…The clinical implication of this finding is that CTD cannot be either suspected or ruled out simply based on BAV-related aortic phenotypes. Apparent discrepancies between our findings and those supporting the peculiarities of the root-phenotype [22,26,27] should be seen cautiously, considering differences of clinical settings possibly resulting into relevant differences among study populations. Our study group was detected in a primary-care setting, while the other studies [22,26,27] were performed in patients referred to cardiac surgery centers for either evaluation or intervention Thus, we believe that this apparent mismatch should be interpreted as an expression of the wide spectrum of BAV syndrome [9,10,30,31].…”

“…The issue of size threshold for aortic surgery in BAV is still debated [22,23], though more recent guidelines lean towards a more conservative approach in BAV patients with isolated TAA [12][13][14]. Indeed, an important agreement has Table1 Demographic and clinical characteristics of the studied BAV and MFS patients BAV bicuspid aortic valve; patients were all assessed according to Ghent-2 criteria (19), MFS Marfan syndrome, ΔAR-AA Delta Aortic Root-Ascending Aorta diameter, * of any kind, † thumb sign is positive when the entire nail of the thumb projects beyond the ulnar border of the hand which is clenched without any assistance, the wrist sign is positive when the thumb overlaps the terminal phalanx of the fifth digit when it grasps the contra-lateral wrist.…”

Witness protection for authors of controversial guidelines

“…Should the diameter-based threshold for surgical intervention in patients with bicuspid aortic valves be lowered even further, to 4 cm? Although the authors make a convincing argument for a lower threshold, 2 Sundt points out weaknesses in their decision-making algorithm and expresses concern that reducing the threshold of repair to a new low could ensnare those with ''innocent'' aortas (ie, those that would not dare dissect or rupture) as unnecessary surgical victims. 1 At the heart of the matter is the balance between maintaining an adequately functioning bicuspid aortic valve for as long as possible and avoiding a life-threatening aortic dissection.…”

“Silent killer” or victim of mistaken identity?

“…colleagues. 1 It is, as we have become accustomed from these authors, clearly written and beautifully illustrated. An algorithm is presented, supported by data concerning the fate of those not undergoing surgical intervention, and a claim of clinical effectiveness is made.…”