Aortic growth & body-size indexing

Growth rate, ASI, area/height · Serial root/ascending measurements with the same modality and convention; CT/MRI confirmation

Normal range & thresholds

• Growth ≥0.5 cm in 1 year, or ≥0.3 cm/year in 2 consecutive years → surgery reasonable (ACC/AHA 2022) ^[9].
• Cross-sectional area/height >10 cm²/m → surgery reasonable in selected patients ^[9].
• EACTS/STS 2024 adds a 52 mm class IIa threshold at low risk and growth criteria ^[10].

Pathophysiology

Dissection risk rises with absolute size, but tall and short patients need indexing, and a fast-growing aorta is dangerous at any size. Measurement convention differences (echo leading-edge vs CT inner-edge) of 2–4 mm exceed true annual growth — the commonest source of false ‘growth’ ^[9,18].

Raised by

• Marfan, Loeys-Dietz, familial TAAD, bicuspid aortopathy, hypertension, Turner

Lowered by

—

Technique & pitfalls

• Same modality, level and convention; confirm growth with gated CT/MRI before acting ^[9].

Pseudo-change & artefact

• Convention/modality switch; oblique planes; systole vs diastole.

Treatment thresholds

• Growth and indexed criteria trigger surgery below absolute thresholds ^[9,10,174].

Next step

• Genetic testing and family screening where indicated ^[9].

Drugs

BP <130/80 mmHg, β-blockers/ARBs slow growth ^[9].

Reversibility

Aneurysms do not regress.