Ascending Aorta

The Common Vein Copyright 2007

Ashley Davidoff MD

Introduction

The ascending aorta is the first segment of the aorta’s structural anatomy. It is located between the left ventricle and the aortic arch. The ascending aorta is characterized by its tubular shape and elastic nature. Contained in the pericardium, the ascending aorta runs superiorly, curving obliquely upwards from right to left as it ascends on the right side.. The segment is generally about 5 cm in length. As it commences from the aortic valve, the ascending aorta gives rise to the two coronary arteries which supply the heart. Common diseases include atherosclerosis, aortic aneurysm. When aortic dissection affects the ascending aorta it is an indication for surgery. Diagnostic studies include CT imaging, echocardiography, MRI, aortography, and echocardiography.  Treatment in general is surgical.

 

Parts

 

 The ascending aorta consists of two parts – the aortic sinus (aka aortic bulb) and the tubular portion, separated by the sinotubular junction. The most proximal portion of the aorta originates just above the attachment of the aortic valves, and it is called aortic sinus

 It houses the 3 sinuses of Valsalva and the coronary ostia. The left and right coronary arteries arise from their respective left and right coronary cusps. The sinotubular junction marks the border between the sinus portion of the aorta and the tubular portion. Diseases such as syphilitic aortitis, usually start at the sinotubular junction and progress distally to the tubular portion. There is no direct involvement of the sinus portion, but the aortic valve may become distorted by the aneurysmal disease with resulting aortic regurgitation.   Ankylosing aortitis on the other hand usually involves the valves causing thickening with subsequent regurgitation. The tubular portion of the ascending aorta extends from the sinotubular junction to the brachiocephalic artery. It has no branches.

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Ascending Aorta Bulbus Portion (2) and Tubular Portion (3)

This diagram shows the two components of the ascending aorta, the bulbous or sinus portion (maroon)and the tubular portion (bright red)that starts at the sinotubular junction and ends at the origin of the brachiocephalic artery. Certain diseases such as syphilitic aortitis affect the tubular portion of the ascending aorta and spare the sinus portion, whereas others such as ankylosing spondylitis affect the aortic sinuses as well as the tubular portion. ascending 03label450.jpg

Normal (a,c) and Aortic Stenosis with Post Stenotic Dilatation (b,d)

07969c06 heart aorta left ventricle LV normal anatomy fx hypercontractile ballet slipper ejection fraction = 80% AV aortic valve thickened doming ejection click jet turbulence shear stress post stenotic dilalation dilitation LV angiogram angiography Courtesy Ashley Davidoff MD aortic valve 07969c03 07969c02 07969c04