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Ascending Aorta [Extra Quality]



The ascending aorta begins right after the left ventricle of the heart and contains the aortic heart valve, which is a flap that opens and closes to allow blood to enter the aorta from the left ventricle. The ascending aorta ends right before the brachiocephalic artery, which is the first branch off the aortic arch.




ascending aorta



The ascending aorta is the first part of the aorta and begins at the sinotubular junction (the junction of the aortic root and ascending aorta) and terminates as it exits the fibrous pericardium where it becomes the aortic arch, in the transthoracic plane (of Ludwig). It is located obliquely just to the left of the midline at the level of the third intercostal space.


It normally has only two branches (although technically these usually arise form the aortic root), the right coronary artery and the left coronary artery. These arise from the right and left aortic sinuses (of Valsalva) respectively, which (along with the non-coronary sinus) are out-pouchings of the aortic wall above each cusp of the aortic valve. Immediately above the three aortic sinuses, the normal tubular configuration of the aorta is attained - at the sinotubular junction.


The ascending aorta ascends slightly towards the right of midline where it can be seen as part of the mediastinal outline on a chest radiograph. This should only be the case in the older ectatic or dilated artery. In a young patient, a prominent ascending aorta, especially when combined with signs of left ventricular hypertrophy should raise suspicion of aortic stenosis.


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.


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]


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]


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.


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.


.mw-parser-output .vanchor>:target.vanchor-textbackground-color:#b1d2ffPorcelain 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]


A technique for complete replacement of the aortic valve and ascending aorta in cases of aneurysm of the ascending aorta with aortic valve ectasia is described. The proximal aortic root was too attenuated to afford anchorage to the aortic prosthesis, so this was sutured to the ring of a Starr valve and the prostheses were inserted en bloc. The ostia of the coronary arteries were anastomosed to the side of the aortic prosthesis.


The aorta is the main blood vessel that carries blood away from your heart and to your body. It is shaped like a walking cane with a curved handle. An ascending aortic aneurysm is an abnormal bulging and weakening in your aorta at the point before the curve.


A thoracic aortic aneurysm occurs when a weak spot in the wall of the aorta begins to bulge, as shown on the left image. Having an aneurysm increases the risk of rupture or a tear in the aorta's lining (dissection), as shown in the image on the right.


An aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's main artery (aorta). Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect). If the blood goes through the outside aortic wall, aortic dissection is often deadly.


The ascending aorta begins above the aortic root and extends towards the neck until it begins to turn and give rise to the aortic arch. The ascending aorta is more frequently affected by aneurysms and dissections and requires open heart surgery to be repaired.


This procedure is indicated for patients who are diagnosed with aneurysm or dissection of the ascending aorta and have an abnormally functioning aortic valve. The procedure involves aortic valve replacement combined with replacement of the ascending aorta and the underside of the aortic arch with a Dacron graft.


This procedure is indicated for patients who are diagnosed with aneurysmal disease involving the aortic root and ascending aorta with abnormal aortic valve leaflets. The procedure involves excision of all diseased aortic root tissue and the aortic valve leaflets, followed by replacement of the aortic root complex with a bioprosthetic (porcine or bovine) valve that is sewn inside a Dacron graft. The left and right main coronary arteries are subsequently reimplanted into the graft with fine permanent suture. The ascending aorta and underside of the aortic arch are replaced with a separate Dacron graft, and the two grafts are connected together to complete the proximal aortic reconstruction.


This procedure is indicated for patients who are diagnosed with an aortic dissection involving the ascending aorta. The procedure involves excision of the ascending aorta and underside of the aortic arch, and placement of a thoracic aortic stent graft into the descending aorta at the time of arch repair. The native aortic valve and root are repaired, and the ascending aorta and proximal arch are replaced with a Dacron graft.


This procedure is indicated for patients who have aneurysmal disease that involves the entire aortic arch. The procedure involves excision of the ascending aorta and aortic arch. The great vessels (innominate, left carotid and left subclavian arteries), which supply the brain and upper extremities, are separated from the arch. The ascending aorta and arch are replaced with a customized, Dacron, multi-branched arch graft, and the great vessels are individually re-attached to the branches of the arch graft.


There are a number of ways to repair or replace the portion of an aorta damaged by an aneurysm. Which option is used will depend on such factors as where your aneurysm is located (whether it's in your ascending aorta or aortic arch, for example, or in your descending aorta), how big it is, and the overall state of your health. Your surgeon will determine which of the following procedures is most appropriate in your particular situation:


The aorta is the first segment of the systemic arterial circulation, originating directly from the left ventricle of the heart. It is the largest artery in the body consisting of three parts that each has its special characteristics, most notably in their direction and orientation. At the beginning of its course, the aorta runs upwards as the ascending aorta then shortly after arches laterally to the left, forming the arch of aorta. After that, the aorta continues downwards as the descending aorta until it divides into its terminal branches.


The aorta is the main artery in the body whose only and important function is to carry oxygenated blood from the heart to the rest of the body. It is important to note that all the arteries of the human body (except the pulmonary arteries), no matter where they are, receive blood from the aorta. This becomes possible by the numerous branches that aorta gives off along its course.


Being the first segment of the systemic circulation, the aorta originates directly from the heart. It begins from the aortic orifice found at the base of the left ventricle. It is separated from the ventricle by the aortic valve, that consists of three semilunar cusps; the right, left and posterior cusp. The aorta is approximately 30 cm long, spanning almost the entire length of the trunk. It is the largest artery in the body, with its largest diameter being approximately 4 cm at the aortic root decreasing with distance; being about 3.5 cm in the ascending aorta, and about 2.5 cm in the abdominal aorta. The main function of the aorta is to transmit oxygenated blood from the heart to the rest of the body.


There are a number of classifications of the aorta. Most common one, and the one we will use in this article, is the classification of the aorta into three parts; the ascending aorta, aortic arch and the descending aorta. The descending aorta is the longest part, further subdivided into thoracic and abdominal aorta, with the diaphragm being the anatomical division between the two.


In addition, the ascending aorta, aortic arch and the thoracic part of the descending aorta are sometimes together referred to as the thoracic aorta, due to them all being confined to the thoracic cavity. This classification describes the aorta as having two parts; the thoracic and abdominal aorta.


The ascending aorta is the first part of the aorta that begins at the aortic orifice on the base of the left ventricle, roughly at the level of the lower border of the third left costal cartilage. From this point, it ascends obliquely superiorly and slightly laterally to the right, and ends at the sternal angle, just before the branching of the brachiocephalic trunk. 041b061a72


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