Cardiovascular Imaging

Aortoannular ectasia

dilatation of the proximal ascending aorta and aortic annulus usually caused by severe degenerative changes of the wall of the aorta. The degenerative change is usually cystic medial necrosis. Some patients with this abnormality have characteristics of Marfans syndrome. Most patients have aortic regurgitation. Complications include thoracic aortic dissection, aneurysm and rupture.

Plain radiography demonstrates marked enlargement of the ascending aorta and cardiomegaly in patients with chronic aortic regurgitation. Echocardiography, CT, and MRI demonstrate enlargement of the sinuses of Valsalva and the proximal two thirds of the ascending aorta. Monitoring of the dimensions of the ascending aorta is generally done with CT or MRI (Fig.1). Doppler echocardiography and colour flow mapping demonstrate aortic insufficiency. Aortic insufficiency can also be documented and quantified using velocity encoded cine MRI. Transoesophageal Echocardiography, CT, or MRI must be employed to exclude dissection in those patients who present with chest pain.

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Fig.1

ECG-gated spin-echo coronal MR image demonstrates dilatation of the aortic annulus and ascending aorta. There is a dissection flap in the distal ascending aorta (arrows).
Aortoannular ectasia, Fig.1