aortic size index calculator aortic size index calculator

Observational studies suggest that the risk of aortic complications in patients with bicuspid aortic valve aortopathy is low overall, though significantly greater than in the general population.6-8 These findings led to changes in the 2014 American College of Cardiology/American Heart Association guidelines on valvular heart disease,9 suggesting a surgical threshold of 5.5 cm in the absence of significant valve disease or family history of dissection of an aorta of smaller diameter, although this was later revised, as explained below. This calculator allows one to determine the ascending aorta morphology on the basis of anthropometric parameters. Raw data was not published. However, weight might not contribute substantially to aortic size and growth. Aortic Root Z-Scores for Adults For patients > 15 years of age and adults: utilizing diastole and leading edge-to-leading edge measurement of the sinuses of valsalva. Patient Prosthesis Mismatch (PPM) Calculator Annulus size: (Insert annulus size below) Area mm 2 Diameter mm Perimeter mm Body height: (Insert body height below) cm m ft Body weight: (Insert body weight below) kg lbs stone Calculate Body Surface Area (BSA) Body Surface Area (BSA) m2: CALCULATE i EOA Reset Evolut Hemodynamic Reference Values A Z score below -2 means the measurement is small for body size and a score larger than +2 means that the measurement is large for body size. A lot of patients with aortic stenosis does not experience any symptoms, however, if the blood flow is greatly reduced, the manifestation of the disease may include: There are different ways of treating aortic stenosis, including medications, valve repair, or valve replacement. Head SJ, Mokhles MM, Osnabrugge RL, et al. Epub 2017 Nov 22. AHI categories 3.05 to 3.69, 3.70 to 4.34, and 4.35 cm/m were associated with a significantly increased risk of complications (P < .05). 2019 May;157(5):1733-1745. doi: 10.1016/j.jtcvs.2018.09.124. Estimated probability of rupture or dissection of the ascending aorta by aneurysm size. Table 3 Threshold values of the diameters, aortic size index, and aortic height index indicating the upper two standard deviations (2 SD, 95%) of the normally distributed data in the subgroup of patients with no hypertension, coronary artery disease, or bicuspid or mechanical aortic valve . PMC Patients with an LV ejection fraction of 36-49% are defined as 'impaired LV ejection fraction'. Wojnarski CM, Svensson LG, Roselli EE, et al. Aortic cross-sectional area/height ratio and outcomes in patients with a trileaflet aortic valve and a dilated aorta. Average annual growth rate of the ascending aorta based on initial aneurysm size. The innominate and left common carotid arteries were grafted and connectedto the main graft. It is calculated as the ratio of the subvalvular velocity obtained by PW Doppler and the maximum velocity obtained by CW Doppler across the prosthetic valve. In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. By Frank Cikach, MD; Milind Y. Desai, MD; Eric E. Roselli, MD; Vidyasagar Kalahasti, MD; and Lars G. Svensson, MD, PhD, Cleveland Clinic is a non-profit academic medical center. Choose from 400+ evidence-based medical calculators- including clinical equations, scores, and dosage formulas for optimal patient treatment at the point of care Yes. J Am Coll Cardiol Img. 2014 May;59(5):1209-16. doi: 10.1016/j.jvs.2013.10.104. In this article, we demonstrate that compared with the BSA-based ASI, the height-based aortic height index (AHI) provides equal or superior prediction of aortic events, as depicted in the area under the curve analysis. Epub 2021 Sep 8. The .gov means its official. This is one of the most common and serious valve disease problems. Sudden, severe chest pain, abdominal pain or back pain. Wolak A, Gransar H, Thomson LJ, et al. Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application? In the subset of patients with severe risks (AHI 4.1cm/m), elective surgical repair should be performed as early as possible. J Am Coll Cardiol. If a mutation is identified in a family, then first-degree relatives should undergo genetic screening for the mutation and aortic imaging.1 Imaging in second-degree relatives may also be considered if one or more first-degree relatives are found to have aortic dilation.1. Patient Prosthesis Mismatch Risk of complications in ascending aortic aneurysm as a function of aortic diameter and height. In light of these findings, a statement of clarification in the American College of Cardiology/American Heart Association guidelines was published in 2015, recommending surgery for patients with an aortic diameter of 5.0 cm or greater if the patient is at low risk and the surgery is performed by an experienced surgical team at a center with established surgical expertise in this condition.11 In addition, indexing a patients height to aortic size was also introduced as an alternative for deciding when to operate. MeSH Karazincir S. et al., "CT assessment of main pulmonary artery diameter," Diagnostic and Interventional Radiology 14(2), 72-74 (2008), Density and QQ plots of raw data, and QQ plot of the Box-Cox transformed data. Consequently, we considered that indexing aortic size to height alone might be a more precise and simpler risk assessment tool. Rapid heart rate. We seek to evaluate the height-based aortic height index (AHI) versus ASI for risk estimation and revisit our natural history calculations. Editor's Note: Please see Part 2 of the Aortic Disease Guideline Key Perspectives. The below equation relies on the ratio of peak-to-peak instantaneous gradients. Epub 2018 Feb 2. Now you know how to calculate aortic valve area. Epub 2018 Feb 1. Does being overweight reduce accuracy in predicting an acute aortic dissection? VT2V_{\text{T}_2}VT2 - Maximal velocity time integral across the valve, in cm\text{cm}cm. At our center, we routinely recommend screening of all first-degree relatives of patients with thoracic aortic aneurysm if there is a suggestion of a family history. 2023 Feb 28;13(1):38-50. doi: 10.21037/cdt-22-477. Time-dependent ROC curves for censored survival data and a diagnostic marker. Aortic imaging with echocardiography plus CT or MRI should be considered to detect asymptomatic disease.1 In patients with a strong family history (i.e., multiple relatives affected with aortic aneurysm, dissection or sudden cardiac death), genetic screening and testing for known mutations are recommended for the patient as well as for the family members. While there are no published guidelines regarding activity restrictions in patients with thoracic aortic aneurysm, we use a graded approach based on aortic diameter: We also recommend not lifting anything heavier than half of ones body weight and to avoid breath-holding or performing the Valsalva maneuver while lifting. Size and other factors. To a cardiologist at the time of diagnosis. How does this stroke volume index calculator work? J Vasc Surg. Patients with an AHI of 3.21 to 4.06cm/m are at high risk, and elective aortic repair should generally be recommended. Now, as our aortic patient database has grown from 230 at the time of our original publications to some 4000 today, we are able to make much more powerful statistical calculations. Another is personal experience, mostly triggered either by adverse outcome in early surgery (should have observed longer) or by adverse aortic events when having observed too long (should have intervened earlier). What is the appropriate size criterion for resection of thoracic aortic aneurysms?. 2023 Feb 21. doi: 10.1007/s10554-023-02794-1. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. References: Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. Raw data was not published; the normality of the sizes within the raw data therefore could not be verified. The 2022 American College of Cardiology/American Heart Association (ACC/AHA) aortic disease guideline provides recommendations on the diagnosis, evaluation, medical therapy, endovascular and surgical intervention, and long-term surveillance of patients with aortic disease across its multiple clinical presentations. 2017, 2017 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery, We use cookies to help provide and enhance our service and tailor content. Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area. Read the article below to get familiar with the aortic valve area formula and reference values for this measurement. Natural history of descending thoracic and thoracoabdominal aortic aneurysms. As an aortic aneurysm grows, you might notice symptoms including: Difficulty breathing or shortness of breath. doi: 10.1016/j.jtcvs.2019.01.026. Epub 2019 Feb 13. Dr. Cikach is a resident physician in Cleveland Clinics Department of Thoracic and Cardiovascular Surgery. Aortic dissection in patients with bicuspid aortic valveassociated aneurysms. Background: It is not intended to provide guidance on diagnosis or treatment. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. This process is affected by several components. Dr. Roselli is Surgical Director of the Aorta Center. However, weight might not contribute substantially to aortic size and growth. But how to do it using our aortic valve calculator? Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. For further reading: Colan SD: Appendix: Normal Echocardiographic Values for Cardiovascular Structures, in Echocardiography in Pediatric and Congenital Heart Disease From Fetus to [] 17-23 These studies are, however, limited by either number of participants, 17-19 fewer aortic landmarks included in the measurements 20, 21 or using non-contrast enhancement CT, 22, 23 for example, previously reported normal . The method used to calculate body surface area is: "Simplified calculation of body-surface area". In light of the fact that TAAA arising in patients with Marfan syndrome and bicuspid aortic valve are distinct, genetically effectuated aortopathies, we repeated the analyses in a cohort devoid of these 2 patient groups, and obtained similar results. All of the references To avoid high-risk emergency surgery on an acutely dissected aorta, surgery on an ascending aortic aneurysm of degenerative etiology is usually suggested when the aneurysm reaches 5.0 to 5.5 cm or a documented growth rate greater than 0.5 cm/year.1,5, Additionally, in patients already undergoing surgery for valvular or coronary disease, prophylactic aortic replacement is recommended if the ascending aorta is larger than 4.5 cm. The aorta is the main artery that carries blood out of the heart to the rest of the body. Discrimination measures for survival outcomes: connection between the AUC and the predictiveness curve. Hiratzka LF, Creager MA, Isselbacher EM, et al. What is normal size of aortic root? Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). However, weight might not contribute substantially to aortic size and growth. The coefficient estimates for both ASI and AHI demonstrate a statistically significant effect on the complication rate (. Patients were stratified into 4 categories of yearly risk of complications based on their ASI and AHI. Outcomes in adults with bicuspid aortic valves. The aneurysm was then resected. A.S., C.A.V., and A.M.M. commonly reported for conditions such as Marfan syndrome, bicuspid aortic valve, and Kawasaki disease. Based on the results of this study, an AHI of 2.43cm/m indicates low risk, but regular radiographic follow-up is recommended. Because of their small stature, ascending aortic diameters of <5 cm may represent significant dilatation; thus, the use of aortic size index is preferred. Feeling full even after a small meal. Survival model predictive accuracy and ROC curves. This can help to identify a patient with an aortic aneurysm who is at increased risk for complications. Address for reprints: John A. Elefteriades, MD, Aortic Institute at Yale-New Haven, Yale University School of Medicine, Clinic Building CB 317 789 Howard Ave, New Haven, CT 06519. As part of our ongoing investigations into the natural history of thoracic aortic aneurysm (TAA), our database at the Aortic Institute at YaleNew Haven Hospital currently includes a total of 3349 patients with TAA. The top and bottom borders of the box indicate the 25th to 75th percentiles, the horizontal line in the middle indicates the median (number in box), the whiskers include values within 1.50-times the interquartile . #^ NpnL9+>IUKsuIu)7[.p`,%K&LXA9 ++-/964^Td[@? Methods Results: for height: 1.519+(age [yrs]*0.010) + (ht [cm]*.010)-(sex [1=M, 2=F]*.247) SEE = 0.215 cm. Central/Eastern Europe, Middle East & Africa. Background: In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. Size indices such as the aortic cross-sectional area indexed to height have been implemented in guidelines for certain patient populations (e.g., > 10 cm 2 /m in Marfan syndrome) and provide better risk stratification than size cutoffs alone. Two decades have elapsed since our original articles regarding the natural history of TAA, based on 230 patients with ascending and descending thoracic aortic aneurysms, were published. Ross procedure. The predicted probability for risk of complication (rupture or dissection) was created from logistic regression. Aortic diameters and long-term complications among 780 patients with TAAA were analyzed. When evaluated by the new AHI risk estimation index, 173 patients (22.2%) changed risk category; 95 (12.2%) went up a category, and 78 (10%) went down a category. The overall fit of the model using AHI was modestly superior according to the concordance statistic. Growth rate estimates, yearly complication rates, and survival were assessed. In 1997, our group first reported on the natural history of the thoracic aorta. The pressure gradient across a stenotic valve is directly related to the valve orifice area and the transvalvular flow [ 1 ]. Dr. Kalahasti is Medical Director of the Marfan and Connective Tissue Disorder Clinic in the Aorta Center. About: This set of echocardiography calculators (formerly known as CardioMath) has been used by thousands of clinicians from nearly every country on the globe for over a decade. doi: 10.1016/j.jtcvs.2019.10.125. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Experimental confirmation of effectiveness of fenestration in acute aortic dissection. October 17, Published online September 18, 2018. Any high risk pain feature. Numbers of patients with IAAs exceeding 10 cm 2 /m are shown in Table 4.The results reflect the fact that the IAA can exceed 10 cm 2 /m at several aortic locations in a given patient. Official reports from the Department of Radiology at YaleNew Haven Hospital were also consulted. 2018 May;155(5):1951-1952. doi: 10.1016/j.jtcvs.2017.11.062. Online ahead of print. Outcomes after elective proximal aortic replacement: a matched comparison of isolated versus multicomponent operations. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Both ASI and AHI were shown to be significant predictors of complications (P < .05). Svensson LG, Khitin L. Aortic cross-sectional area/height ratio timing of aortic surgery in asymptomatic patients with Marfan syndrome. A significant difference (P is smaller than 0.001) in aortic root diameters existed between men and women which could not be explained by differences in body surface area. Relative importance of aneurysm diameter and body size for predicting abdominal aortic aneurysm rupture in men and women. Multivariate analysis using a Cox proportional hazards model was performed to assess and identify the risk factors for major adverse events (death; dissection, or rupture and a composite endpoint including all 3). Patients were stratified into 4 categories of yearly risk of complications based on their ASI and AHI. 2018 May;155(5):1925. doi: 10.1016/j.jtcvs.2017.11.053. This condition is associated with the restriction of the blood flow from the left ventricle to the aorta, which can also affect the pressure in the left atrium. In patients with young children, we recommend obtaining an echocardiogram of the child to look for a bicuspid aortic valve or aortic dilation. In accordance with JTCVS preference, we provide a surgical video illustrating a prophylactic operation in a patient with an ascending aortic aneurysm involving the arch and great vessels. Cleveland Clinic is a non-profit academic medical center. We do not endorse non-Cleveland Clinic products or services Policy. is rarely associated with significant elevations in blood pressure and should be encouraged. 1 Disclaimer. An AHI of 2.44 to 3.17cm/m indicates moderate risk and warrants at least close radiographic follow-up. Stressful emotional states have been anecdotally associated with aortic dissection; thus, measures to reduce stress may offer some benefit.2. Where: Stroke volume = Cardiac Output / Heart rate in bpm. Blood flows out of the heart and into the aorta through the aortic valve. Activity restrictions for patients with thoracic aortic aneurysm are largely based on theory and empirical experience, and certain activities may require more modification than others. Based on the ASI, patients were stratified in to three risk categories and surgical intervention was recommended for . We hope this nomogram is useful to clinicians in the difficult process of making the decision to proceed with prophylactic aortic surgery based on aortic diameter in asymptomatic patients. In 2006, our group presented a nomogram that allowed interpretation of aortic size significance in relationship to a patient's body surface area (BSA). This site needs JavaScript to work properly. Davies RR, Goldstein LJ, Coady MA, et al. The authors are fromo Yale University. Data are expressed as meanstandard deviation and range for continuous variables and as number (percentage) for categorical variables. Atypical aortic arch branching variants: a novel marker for thoracic aortic disease. Aneurysm syndromes caused by mutations in the TGF-beta receptor. If the aortic dimensions remain stable, annual follow-up with CT or MRA is reasonable.1. In a recent study by Masri and colleagues. For this risk of complication analysis, the aortic size groups were divided with 0.5-cm breakdown points (3.5-3.9, 4.0-4.4, 4.5-4.9, 5.0-5.4, 5.5-5.9, 6.0cm), and 4.0 to 4.4cm was set as the comparison group. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Now we find that we can indeed leave the patient's weight out of consideration, with equal or better discriminatory power. Bookshelf Idrees JJ, Roselli EE, Lowry AM, et al. PPM Calculator. Deep hypothermic circulatory arrest was instituted. On and off pump CABG. Z-scores of the aortic root (aortic annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta) are The aortic arch was excised. Calculator uses expected aortic diameter from sex-, age . Read the article below to get familiar with the aortic valve area formula and reference values for this measurement. We displayed hinge points at which aortic rupture or dissection occurred, without any correction for a patient's body size. contributed equally to this work. Advertising on our site helps support our mission. Geronzi L, Haigron P, Martinez A, Yan K, Rochette M, Bel-Brunon A, Porterie J, Lin S, Marin-Castrillon DM, Lalande A, Bouchot O, Daniel M, Escrig P, Tomasi J, Valentini PP, Biancolini ME. Derivation from the graph published in the article (figure 2) was therefore necessary. Does being overweight reduce accuracy in predicting an acute aortic dissection? May 18, 2010;121(19):2123-2129. Based on these results, an aortic diameter-to-patient height ratio of 2.43 cm/m indicates lower risk, 2.44-3.17 cm/m indicates moderate risk warranting close radiographic follow-up, 3.21-4.06 cm/m indicates high risk, and 4.1 cm/m represents severe risk. Message from the Emeritus Director. In Vivo Indexed Effective Orifice Area (iEOA). Velocity Ratio. When the left ventricle contracts, the pressure rises in the left ventricle, and once it is above the pressure in the aorta, the aortic valve to open and allows blood flow into the aorta and thereby into the rest of the body. A Z score of zero means that the aortic measurement is the average size for a girl with TS with that height and weight. Click OK to confirm you are a Healthcare Professional. 1 The normal diameter of the abdominal aorta is regarded to be less than 3.0 cm. Again, no gender differences in the degree of dilatation were . Thoracoabdominal aortic aneurysm surgery. Aortic cross-sectional area/height ratio timing of aortic surgery in asymptomatic patients with Marfan syndrome. Aortic valve morphology (bicuspid or trileaflet) was confirmed by direct visual inspection during aortic aneurysm surgery or by echocardiography in patients who did not undergo aneurysm surgery. Aortic valve area calculator (AVA calculator) allows you to indirectly determine someone's aortic valve area. Wu J, Wu Y, Li F, Zhuang D, Cheng Y, Chen Z, Yang J, Liu J, Li X, Fan R, Sun T. Front Cardiovasc Med. The formula D(mm) can be used to calculate the upper normal limit for ascending aorta. Additional recommendations for screening of family members and referral to clinical geneticists can be discussed at this juncture. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)32769-1/fulltext. Key clinicians from our Aorta Center share guidance on care from referral to medical and surgical management to patient and family follow-up. Thoracic Aortic Aneurysm. Logistic regression analysis of factors predicting the composite endpoint of rupture and dissection, based on aortic size, KaplanMeier estimates of freedom from death (A), rupture or dissection (B), and rupture, dissection, or death (C) as stratified by aortic height index (, KaplanMeier estimates of freedom from death (A), rupture or dissection (B), and rupture, dissection, or death (C) as stratified by aortic size index (, Cox proportional hazards regression for freedom from death (A), rupture or dissection (B), and rupture, dissection, or death (C) as stratified by aortic size index (, Cox proportional hazards regression for freedom from death (A), rupture or dissection (B), and rupture, dissection, or death (C) as stratified by aortic height index (, Factors predicting the composite endpoint of rupture, dissection, and death based on aortic size index and aortic height index. It is important to keep in mind that natural history studies on the aorta, and the calculations in this study, are based on observed size at the time of dissection. Ascending aortic geometry and its relationship to the biomechanical properties of aortic tissue. Valve sparing aortic root replacement - David procedure. Pape LA, Tsai TT, Isselbacher EM, et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. Finding an aortic aneurysm before it ruptures offers your best chance of recovery. Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area. You can use it to evaluate the severity of aortic stenosis. If you want to know more about aortic stenosis, check the American Heart Association website. This information was most useful for very small and very large patients. This method still measures the effective orifice area (EOA), which is the primary predictor of outcomes. ASIs (cm/m. Hanigk M, Burgstaller E, Latus H, Shehu N, Zimmermann J, Martinoff S, Hennemuth A, Ewert P, Stern H, Meierhofer C. Cardiovasc Diagn Ther. This avoids the need to calculate BSA from a computer site. TAA size is the strongest predictor of acute aortic syndromes. Please enable it to take advantage of the complete set of features! You just clicked a link to go to another website. Using relevant parameters, we don't calculate the surface area directly from geometric measurements! In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. 2023 Feb 23;10:1002832. doi: 10.3389/fcvm.2023.1002832. PB00if;'\kap P a!9al'tiBW PK ! Aortic size, age, and sex were included in the analysis. 2008;1(2):200-209. A patient was considered to have Marfan syndrome if confirmed by genetic testing or if manifesting classic clinical stigmata of the disease, as judged by the senior author (J.A.E). Epub 2019 Sep 13. 11 In addition, men have a larger aortic diameter than women. Share via: Treatment should be tailored to the patients clinical scenario, the site of the aneurysm, family history and the estimated risk of rupture or dissection, balanced against the individual centers outcomes of elective aortic replacement.3, For example, young and otherwise healthy patients with thoracic aortic aneurysm and a family history of aortic dissection (who may be more likely to have connective tissue disorders such as Marfan syndrome, Loeys-Dietz syndrome or vascular Ehler-Danlos syndrome) may elect to undergo repair when the aneurysm reaches or nearly reaches the diameter of that of the family members aorta when dissection occurred.1 On the other hand, an aneurysm of degenerative etiology (e.g., related to smoking or hypertension) measuring less than 5.0 to 5.5 cm in an older patient with comorbidities poses a lower risk of a catastrophic event such as dissection or rupture than the risk of surgery.4, Thresholds for surgery. THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY RECOMMENDATIONS FOR CARDIAC CHAMBER QUANTIFICATION IN ADULTS: A QUICK REFERENCE GUIDE FROM THE ASE WORKFLOW AND LAB MANAGEMENT TASK FORCE Accurate and reproducible assessment of cardiac chamber size and function is essential for clinical care. Please enter a term before submitting your search. Clipboard, Search History, and several other advanced features are temporarily unavailable. https://doi.org/10.1016/j.jtcvs.2017.10.140, Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm, View Large The innominate and left common carotid arteries were grafted and connectedto the main graft. The predictive value of AHI and ASI was compared. Background: To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Accessibility 17 to 33 mm The normal range of aortic root diameters in this group was 17 to 33 mm (mean 23.7). Your use of the other site is subject to the terms of use and privacy statement on that site. ASIs (cm/m2) of 2.05, 2.08 to 2.95, 3.00 to 3.95 and 4, and AHIs (cm/m) of 2.43, 2.44 to 3.17, 3.21 to 4.06, and 4.1 were associated with a 4%, 7%, 12%, and 18% average yearly risk of complications, respectively. You will need three values to perform the calculations: Let's assume that for our exemplary patient those values are equal to 2.5cm2.5\ \text{cm}2.5cm, 25cm25\ \text{cm}25cm, and 50cm50\ \text{cm}50cm, respectively. The specific manner in which these measurements are obtained is of obvious importance. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Height supersedes weight: Height-diameter indexing keeps you ahead of the game. In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. Reports lacking accompanying images that could be measured were strictly excluded from the study. KaplanMeier and Cox proportional hazard models were used to estimate 5-year event-free survival. 18 In patients who have no other conditions, the guidelines recommend surgery when the aortic root, ascending aorta, or aortic arch reaches 5.5 cm and when the descending aorta reaches 6.0 cm ( 5.5 cm with endovascular stenting). To a clinical geneticist. Proposing a major heart operation to a symptom-free and otherwise healthy patient with a dilated aorta is not always easy and carries a lot of responsibility for the surgeon and a lot of stress for the patient. (Also see this page for reference values for adults.). The aortic valve is a valve found in the human heart. In international guidelines, preemptive surgical intervention criteria for thoracic ascending aortic aneurysm (TAAA) are based on absolute raw aortic diameter: 5.5cm for asymptomatic TAAA and between 4.0 and 5.0cm for various genetically effectuated aortopathies. Background: To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex).