title: Aortic diameter predicts acute type A aortic dissection in patients with Marfan syndrome but not in patients without Marfan syndrome.
abstract: OBJECTIVE
  Among the parameters for surveillance of patients at risk of acute type A aortic dissection, the aortic size has been considered a cardinal factor. Preventive surgery of the aorta in asymptomatic patients on the basis of size alone is still controversial in patient populations lacking other risk factors for aortic dissection. The aim of the present study was to assess the value of the aortic diameter as a current criterion for elective aortic surgery to prevent the development of aortic dissection in patients without and with Marfan syndrome (MFS).
  
  
  METHODS
  We reviewed the data from patients diagnosed with acute type A aortic dissection from December 1994 to March 2009 at our institute. A total of 237 patients who presented with acute type A aortic dissection were enrolled, of whom 31 were diagnosed with MFS.
  
  
  RESULTS
  The maximal ascending aorta size was 46.7 mm (range, 42.9-51.6) in non-MFS patients and 58.5 mm (range, 43.8-64.9) in MFS patients (P < .001). Two thirds (74%) of the MFS patients had a maximal aortic root size of ≥45 mm. However, 87% of the 206 non-MFS patients had an aortic diameter <55 mm. Non-MFS patients presenting with an aortic size <55 mm developed aortic dissection at a younger age and had a higher body mass index than those with an aortic size ≥55 mm.
  
  
  CONCLUSIONS
  Type A aortic dissection occurs in smaller aortas in non-MFS patients compared with those with MFS.
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Eun Kyoung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.affiliation: Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: dkkim@skku.edu.
authors.forename: Duk-Kyung
authors.initials: DK
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D003661:Decision Support Techniques; D004108:Dilatation, Pathologic; D017558:Elective Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures; D055815:Young Adult