Ascending aorta

Last updated

Ascending aorta
Gray506.svg
The ascending aorta and aortic arch with their branches
Relations of the aorta, trachea, esophagus and other heart structures.png
Course of the ascending aorta (anterior view), as it passes dorsally to the pulmonary trunk but ventrally to the right pulmonary artery.
Details
Precursor Truncus arteriosus
Source Left ventricle
Branches Left coronary artery, right coronary artery and continues as the aortic arch
Vein Combination of superior and inferior vena cava and coronary sinus
SuppliesThe entire body, with exception of the respiratory zone of the lung
Identifiers
Latin aorta ascendens,
pars ascendens aortae
TA98 A12.2.03.001
TA2 4176
FMA 3736
Anatomical terminology

The ascending aorta (AAo) [1] is a portion of the aorta commencing at the upper part of the base of the left ventricle, on a level with the lower border of the third costal cartilage behind the left half of the sternum.

Contents

Structure

It passes obliquely upward, forward, and to the right, in the direction of the heart's axis, as high as the upper border of the second right costal cartilage, describing a slight curve in its course, and being situated, about 6 centimetres (2.4 in) behind the posterior surface of the sternum. The total length is about 5 centimetres (2.0 in).

Components

The aortic root is the portion of the aorta beginning at the aortic annulus and extending to the sinotubular junction. It is sometimes regarded as a part of the ascending aorta, [2] and sometimes regarded as a separate entity from the rest of the ascending aorta. [3]

Between each commissure of the aortic valve and opposite the cusps of the aortic valve, three small dilatations called the aortic sinuses.

The sinotubular junction is the point in the ascending aorta where the aortic sinuses end and the aorta becomes a tubular structure.

Size

A thoracic aorta diameter greater than 3.5 cm is generally considered dilated, whereas a diameter greater than 4.5 cm is generally considered to be a thoracic aortic aneurysm. [4] Still, the average diameter in the population varies by for example age and sex. The upper limit of standard reference range of the ascending aorta may be up to 4.3 cm among large, elderly individuals. [5]

Relations

At the union of the ascending aorta with the aortic arch the caliber of the vessel is increased, owing to a bulging of its right wall.

This dilatation is termed the bulb of the aorta, and on transverse section presents a somewhat oval figure.

The ascending aorta is contained within the pericardium, and is enclosed in a tube of the serous pericardium, common to it and the pulmonary artery.

The ascending aorta is covered at its commencement by the trunk of the pulmonary artery and the right auricula, and, higher up, is separated from the sternum by the pericardium, the right pleura, the anterior margin of the right lung, some loose areolar tissue, and the remains of the thymus; posteriorly, it rests upon the left atrium and right pulmonary artery.

On the right side, it is in relation with the superior vena cava and right atrium, the former lying partly behind it; on the left side, with the pulmonary artery.

Branches

The only branches of the ascending aorta are the two coronary arteries which supply the heart; they arise near the commencement of the aorta from the aortic sinuses which are opposite the aortic valve.

Clinical significance

Porcelain aorta is extensive atherosclerotic calcification of the ascending aorta. [6] It makes aortic surgery difficult, especially aortic cross-clamping, and incisions may result in excessive aortic injury and/or arterial embolism. [6]

The ascending aorta segment is of significant due to its susceptibility to aortic dissection, two times more than in the descending aorta. Early detection of dissection is critical because it allows for prompt intervention to prevent potentially life-threatening complications. [7]

Diagnostics

Diagnostic methods such as echocardiography, magnetic resonance imaging (MRI) and computed tomography (CT) scans, often with contrast enhancement, are used in the detection of pathology and evaluation of ascending aorta.

Images

Related Research Articles

<span class="mw-page-title-main">Aorta</span> Largest artery in the human body

The aorta is the main and largest artery in the human body, originating from the left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at the aortic bifurcation into two smaller arteries. The aorta distributes oxygenated blood to all parts of the body through the systemic circulation.

<span class="mw-page-title-main">Brachiocephalic artery</span> Artery of the mediastinum

The brachiocephalic artery, brachiocephalic trunk, or innominate artery is an artery of the mediastinum that supplies blood to the right arm, head, and neck.

<span class="mw-page-title-main">Aortic dissection</span> Injury to the innermost layer of the aorta

Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Vomiting, sweating, and lightheadedness may also occur. Damage to other organs may result from the decreased blood supply, such as stroke, lower extremity ischemia, or mesenteric ischemia. Aortic dissection can quickly lead to death from insufficient blood flow to the heart or complete rupture of the aorta.

<span class="mw-page-title-main">Pulmonary artery</span> Artery in pulmonary circulation carrying deoxygenated blood from heart to lungs

A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the main pulmonary artery or pulmonary trunk from the heart, and the smallest ones are the arterioles, which lead to the capillaries that surround the pulmonary alveoli.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.

<span class="mw-page-title-main">Bicuspid aortic valve</span> Medical condition

Bicuspid aortic valve (BAV) is a form of heart disease in which two of the leaflets of the aortic valve fuse during development in the womb resulting in a two-leaflet (bicuspid) valve instead of the normal three-leaflet (tricuspid) valve. BAV is the most common cause of heart disease present at birth and affects approximately 1.3% of adults. Normally, the mitral valve is the only bicuspid valve and this is situated between the heart's left atrium and left ventricle. Heart valves play a crucial role in ensuring the unidirectional flow of blood from the atrium to the ventricles, or from the ventricle to the aorta or pulmonary trunk. BAV is normally inherited.

<span class="mw-page-title-main">Aneurysm of sinus of Valsalva</span> Medical condition

Aneurysm of the aortic sinus, also known as the sinus of Valsalva, is a rare abnormality of the aorta, the largest artery in the body. The aorta normally has three small pouches that sit directly above the aortic valve, and an aneurysm of one of these sinuses is a thin-walled swelling. Aneurysms may affect the right (65–85%), non-coronary (10–30%), or rarely the left coronary sinus. These aneurysms may not cause any symptoms but if large can cause shortness of breath, palpitations or blackouts. Aortic sinus aneurysms can burst or rupture into adjacent cardiac chambers, which can lead to heart failure if untreated.

<span class="mw-page-title-main">Thoracic aortic aneurysm</span> Medical condition

A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax.

<span class="mw-page-title-main">Aortic sinus</span>

An aortic sinus, also known as a sinus of Valsalva, is one of the anatomic dilations of the ascending aorta, which occurs just above the aortic valve. These widenings are between the wall of the aorta and each of the three cusps of the aortic valve.

A transthoracic echocardiogram (TTE) is the most common type of echocardiogram, which is a still or moving image of the internal parts of the heart using ultrasound. In this case, the probe is placed on the chest or abdomen of the subject to get various views of the heart. It is used as a non-invasive assessment of the overall health of the heart, including a patient's heart valves and degree of heart muscle contraction. The images are displayed on a monitor for real-time viewing and then recorded.

<span class="mw-page-title-main">Bronchial artery</span> Blood vessels supplying the lungs

In human anatomy, the bronchial arteries supply the lungs with oxygenated blood, and nutrition. Although there is much variation, there are usually two bronchial arteries that run to the left lung, and one to the right lung, and are a vital part of the respiratory system.

<span class="mw-page-title-main">Thoracic aorta</span> Part of the aorta located in the thorax

The thoracic aorta is a part of the aorta located in the thorax. It is a continuation of the aortic arch. It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity. The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic hiatus in the diaphragm where it becomes the abdominal aorta.

<span class="mw-page-title-main">Aortic arch</span> Part of the aorta

The aortic arch, arch of the aorta, or transverse aortic arch is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea.

<span class="mw-page-title-main">Arterial switch operation</span> Open heart surgical procedure

Arterial switch operation (ASO) or arterial switch, is an open heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA).

The Bentall procedure is a type of cardiac surgery involving composite graft replacement of the aortic valve, aortic root, and ascending aorta, with re-implantation of the coronary arteries into the graft. This operation is used to treat combined disease of the aortic valve and ascending aorta, including lesions associated with Marfan syndrome. The Bentall procedure was first described in 1968 by Hugh Bentall and Antony De Bono. It is considered a standard for individuals who require aortic root replacement, and the vast majority of individuals who undergo the surgery receive mechanical valves.

<span class="mw-page-title-main">Ross procedure</span> Type of cardiac surgical operation

The Ross procedure, also known as pulmonary autograft, is a heart valve replacement operation to treat severe aortic valve disease, such as in children and young adults with a bicuspid aortic valve. It involves removing the diseased aortic valve, situated at the exit of the left side of the heart, and replacing it with the person's own healthy pulmonary valve (autograft), removed from the exit of the heart's right side. To reconstruct the right sided exit, a pulmonary valve from a cadaver (homograft), or a stentless xenograft, is used to replace the removed pulmonary valve. Compared to a mechanical valve replacement, it avoids the requirement for thinning the blood, has favourable blood flow dynamics, allows growth of the valve with growth of the child and has less risk of endocarditis.

<span class="mw-page-title-main">Annuloaortic ectasia</span> Medical condition

Annuloaortic ectasia is characterized by pure aortic valve regurgitation and aneurysmal dilatation of the ascending aorta. Men are more likely than women to develop idiopathic annuloaortic ectasia, which usually manifests in the fourth or sixth decades of life. Additional factors that contribute to this condition include osteogenesis imperfecta, inflammatory aortic diseases, intrinsic valve disease, Loeys-Dietz syndrome, Marfan syndrome, and operated congenital heart disease.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

<span class="mw-page-title-main">Familial aortic dissection</span> Medical condition

Familial aortic dissection or FAD refers to the splitting of the wall of the aorta in either the arch, ascending or descending portions. FAD is thought to be passed down as an autosomal dominant disease and once inherited will result in dissection of the aorta, and dissecting aneurysm of the aorta, or rarely aortic or arterial dilation at a young age. Dissection refers to the actual tearing open of the aorta. However, the exact gene(s) involved has not yet been identified. It can occur in the absence of clinical features of Marfan syndrome and of systemic hypertension. Over time this weakness, along with systolic pressure, results in a tear in the aortic intima layer thus allowing blood to enter between the layers of tissue and cause further tearing. Eventually complete rupture of the aorta occurs and the pleural cavity fills with blood. Warning signs include chest pain, ischemia, and hemorrhaging in the chest cavity. This condition, unless found and treated early, usually results in death. Immediate surgery is the best treatment in most cases. FAD is not to be confused with PAU and IMH, both of which present in ways similar to that of familial aortic dissection.

The heart is a muscular organ situated in the mediastinum. It consists of four chambers, four valves, two main arteries, and the conduction system. The left and right sides of the heart have different functions: the right side receives de-oxygenated blood through the superior and inferior venae cavae and pumps blood to the lungs through the pulmonary artery, and the left side receives saturated blood from the lungs.

References

PD-icon.svgThis article incorporates text in the public domain from page 545 of the 20th edition of Gray's Anatomy (1918)

  1. Logan, Carolynn M.; Rice, M. Katherine (1987). Logan's Medical and Scientific Abbreviations . Philadelphia: J. B. Lippincott Company. p.  3. ISBN   0-397-54589-4.
  2. Nataf, P (2006). "Dilation of the thoracic aorta: medical and surgical management". Heart. 92 (9): 1345–1352. doi:10.1136/hrt.2005.074781. ISSN   1355-6037. PMC   1861150 . PMID   16908722.
  3. Freeman, Laura A.; Young, Phillip M.; Foley, Thomas A.; Williamson, Eric E.; Bruce, Charles J.; Greason, Kevin L. (2013). "CT and MRI Assessment of the Aortic Root and Ascending Aorta". American Journal of Roentgenology. 200 (6): W581–W592. doi:10.2214/AJR.12.9531. ISSN   0361-803X. PMID   23701088.
  4. Bret P Nelson (October 1, 2015). "Thoracic Aneurysm". Medscape . Retrieved April 16, 2017.
  5. Wolak, Arik; Gransar, Heidi; Thomson, Louise E.J.; Friedman, John D.; Hachamovitch, Rory; Gutstein, Ariel; Shaw, Leslee J.; Polk, Donna; Wong, Nathan D.; Saouaf, Rola; Hayes, Sean W.; Rozanski, Alan; Slomka, Piotr J.; Germano, Guido; Berman, Daniel S. (2008). "Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area". JACC: Cardiovascular Imaging. 1 (2): 200–209. doi: 10.1016/j.jcmg.2007.11.005 . ISSN   1936-878X. PMID   19356429.
  6. 1 2 Van Mieghem, Nicolas M.; Van Der Boon, Robert M.A. (2013). "Porcelain Aorta and Severe Aortic Stenosis: Is Transcatheter Aortic Valve Implantation the New Standard?". Revista Española de Cardiología (English Edition). 66 (10): 765–767. doi:10.1016/j.rec.2013.05.008. ISSN   1885-5857. PMID   24773854.
  7. "Aortic Dissection: Causes, Symptoms & Treatments". Cleveland Clinic. Retrieved March 12, 2024.