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Ascending tubular aorta aneurysm

MedGen UID:
163631
Concept ID:
C0856747
Anatomical Abnormality
Synonyms: Ascending aortic aneurysm; Ascending aortic dilation
SNOMED CT: Aneurysm of ascending aorta (425963007)
 
HPO: HP:0004970

Definition

An abnormal localized widening (dilatation) of the tubular part of the ascending aorta. [from HPO]

Conditions with this feature

Marfan syndrome
MedGen UID:
44287
Concept ID:
C0024796
Disease or Syndrome
FBN1-related Marfan syndrome (Marfan syndrome), a systemic disorder of connective tissue with a high degree of clinical variability, comprises a broad phenotypic continuum ranging from mild (features of Marfan syndrome in one or a few systems) to severe and rapidly progressive neonatal multiorgan disease. Cardinal manifestations involve the ocular, skeletal, and cardiovascular systems. Ocular findings include myopia (>50% of affected individuals); ectopia lentis (seen in approximately 60% of affected individuals); and an increased risk for retinal detachment, glaucoma, and early cataracts. Skeletal system manifestations include bone overgrowth and joint laxity; disproportionately long extremities for the size of the trunk (dolichostenomelia); overgrowth of the ribs that can push the sternum in (pectus excavatum) or out (pectus carinatum); and scoliosis that ranges from mild to severe and progressive. The major morbidity and early mortality in Marfan syndrome relate to the cardiovascular system and include dilatation of the aorta at the level of the sinuses of Valsalva (predisposing to aortic tear and rupture), mitral valve prolapse with or without regurgitation, tricuspid valve prolapse, and enlargement of the proximal pulmonary artery. Severe and prolonged regurgitation of the mitral and/or aortic valve can predispose to left ventricular dysfunction and occasionally heart failure. With proper management, the life expectancy of someone with Marfan syndrome approximates that of the general population.
Cutis laxa, autosomal recessive, type 1A
MedGen UID:
78663
Concept ID:
C0268351
Disease or Syndrome
FBLN5-related cutis laxa is characterized by cutis laxa, early childhood-onset pulmonary emphysema, peripheral pulmonary artery stenosis, and other evidence of a generalized connective disorder such as inguinal hernias and hollow viscus diverticula (e.g., intestine, bladder). Occasionally, supravalvar aortic stenosis is observed. Intrafamilial variability in age of onset is observed. Cardiorespiratory failure from complications of pulmonary emphysema (respiratory or cardiac insufficiency) is the most common cause of death.
Deletion of long arm of chromosome 18
MedGen UID:
96605
Concept ID:
C0432443
Disease or Syndrome
Monosomy 18q is a partial deletion of the long arm of chromosome 18 characterized by highly variable phenotype, most commonly including hypotonia, developmental delay, short stature, growth hormone deficiency, hearing loss and external ear anomalies, intellectual disability, palatal defects, dysmorphic facial features, skeletal anomalies (foot deformities, tapering fingers, scoliosis) and mood disorders.
Multiple self-healing squamous epithelioma
MedGen UID:
154270
Concept ID:
C0546476
Neoplastic Process
Individuals with multiple self-healing squamous epithelioma (MSSE) develop multiple invasive skin tumors that undergo spontaneous regression leaving pitted scars. Age at onset is highly variable, ranging from 8 to 62 years. The disorder shows autosomal dominant inheritance, and most affected families have originated from western Scotland (Bose et al., 2006). MSSE has been considered to be a variety of multiple keratoacanthoma (Biskind et al., 1957; Haydey et al., 1980).
X-linked intellectual disability with marfanoid habitus
MedGen UID:
167096
Concept ID:
C0796022
Disease or Syndrome
MED12-related disorders include the phenotypes of FG syndrome type 1 (FGS1), Lujan syndrome (LS), X-linked Ohdo syndrome (XLOS), Hardikar syndrome (HS), and nonspecific intellectual disability (NSID). FGS1 and LS share the clinical findings of cognitive impairment, hypotonia, and abnormalities of the corpus callosum. FGS1 is further characterized by absolute or relative macrocephaly, tall forehead, downslanted palpebral fissures, small and simple ears, constipation and/or anal anomalies, broad thumbs and halluces, and characteristic behavior. LS is further characterized by large head, tall thin body habitus, long thin face, prominent nasal bridge, high narrow palate, and short philtrum. Carrier females in families with FGS1 and LS are typically unaffected. XLOS is characterized by intellectual disability, blepharophimosis, and facial coarsening. HS has been described in females with cleft lip and/or cleft palate, biliary and liver anomalies, intestinal malrotation, pigmentary retinopathy, and coarctation of the aorta. Developmental and cognitive concerns have not been reported in females with HS. Pathogenic variants in MED12 have been reported in an increasing number of males and females with NSID, with affected individuals often having clinical features identified in other MED12-related disorders.
Aortic aneurysm, familial thoracic 4
MedGen UID:
338704
Concept ID:
C1851504
Disease or Syndrome
Any familial thoracic aortic aneurysm and aortic dissection in which the cause of the disease is a mutation in the MYH11 gene.
Aortic aneurysm, familial thoracic 6
MedGen UID:
435866
Concept ID:
C2673186
Disease or Syndrome
Any familial thoracic aortic aneurysm and aortic dissection in which the cause of the disease is a mutation in the ACTA2 gene.
Loeys-Dietz syndrome 2
MedGen UID:
382398
Concept ID:
C2674574
Disease or Syndrome
Loeys-Dietz syndrome (LDS) is characterized by vascular findings (cerebral, thoracic, and abdominal arterial aneurysms and/or dissections), skeletal manifestations (pectus excavatum or pectus carinatum, scoliosis, joint laxity, arachnodactyly, talipes equinovarus, cervical spine malformation and/or instability), craniofacial features (widely spaced eyes, strabismus, bifid uvula / cleft palate, and craniosynostosis that can involve any sutures), and cutaneous findings (velvety and translucent skin, easy bruising, and dystrophic scars). Individuals with LDS are predisposed to widespread and aggressive arterial aneurysms and pregnancy-related complications including uterine rupture and death. Individuals with LDS can show a strong predisposition for allergic/inflammatory disease including asthma, eczema, and reactions to food or environmental allergens. There is also an increased incidence of gastrointestinal inflammation including eosinophilic esophagitis and gastritis or inflammatory bowel disease. Wide variation in the distribution and severity of clinical features can be seen in individuals with LDS, even among affected individuals within a family who have the same pathogenic variant.
Chromosome 1q21.1 deletion syndrome
MedGen UID:
393913
Concept ID:
C2675897
Congenital Abnormality
The 1q21.1 recurrent microdeletion itself does not appear to lead to a clinically recognizable syndrome as some persons with the deletion have no obvious clinical findings and others have variable findings that most commonly include microcephaly (50%), mild intellectual disability (30%), mildly dysmorphic facial features, and eye abnormalities (26%). Other findings can include cardiac defects, genitourinary anomalies, skeletal malformations, and seizures (~15%). Psychiatric and behavioral abnormalities can include autism spectrum disorders, attention deficit hyperactivity disorder, autistic features, and sleep disturbances.
Moyamoya disease 5
MedGen UID:
481320
Concept ID:
C3279690
Disease or Syndrome
Moyamoya disease is a cerebrovascular disorder caused by stenotic changes of terminal portions of the internal carotid arteries accompanied by surrounding fine arterial collateral vessels. These vascular networks resemble a 'puff of smoke' (Japanese: moyamoya) in angiographic imaging (summary by Roder et al., 2011). For a general phenotypic description and a discussion of genetic heterogeneity of moyamoya disease, see MYMY1 (252350).
Cutis laxa, autosomal recessive, type 1B
MedGen UID:
482428
Concept ID:
C3280798
Disease or Syndrome
EFEMP2-related cutis laxa, or autosomal recessive cutis laxa type 1B (ARCL1B), is characterized by cutis laxa and systemic involvement, most commonly arterial tortuosity, aneurysms, and stenosis; retrognathia; joint laxity; and arachnodactyly. Severity ranges from perinatal lethality as a result of cardiopulmonary failure to manifestations limited to the vascular and craniofacial systems.
Heterotaxy, visceral, 5, autosomal
MedGen UID:
501198
Concept ID:
C3495537
Congenital Abnormality
Heterotaxy ('heter' meaning 'other' and 'taxy' meaning 'arrangement'), or situs ambiguus, is a developmental condition characterized by randomization of the placement of visceral organs, including the heart, lungs, liver, spleen, and stomach. The organs are oriented randomly with respect to the left-right axis and with respect to one another (Srivastava, 1997). Heterotaxy is a clinically and genetically heterogeneous disorder. For a discussion of genetic heterogeneity of visceral heterotaxy, see HTX1 (306955).
Loeys-Dietz syndrome 4
MedGen UID:
766676
Concept ID:
C3553762
Disease or Syndrome
Loeys-Dietz syndrome (LDS) is characterized by vascular findings (cerebral, thoracic, and abdominal arterial aneurysms and/or dissections), skeletal manifestations (pectus excavatum or pectus carinatum, scoliosis, joint laxity, arachnodactyly, talipes equinovarus, cervical spine malformation and/or instability), craniofacial features (widely spaced eyes, strabismus, bifid uvula / cleft palate, and craniosynostosis that can involve any sutures), and cutaneous findings (velvety and translucent skin, easy bruising, and dystrophic scars). Individuals with LDS are predisposed to widespread and aggressive arterial aneurysms and pregnancy-related complications including uterine rupture and death. Individuals with LDS can show a strong predisposition for allergic/inflammatory disease including asthma, eczema, and reactions to food or environmental allergens. There is also an increased incidence of gastrointestinal inflammation including eosinophilic esophagitis and gastritis or inflammatory bowel disease. Wide variation in the distribution and severity of clinical features can be seen in individuals with LDS, even among affected individuals within a family who have the same pathogenic variant.
Aortic aneurysm, familial thoracic 10
MedGen UID:
924785
Concept ID:
C4284414
Disease or Syndrome
Any familial thoracic aortic aneurysm and aortic dissection in which the cause of the disease is a mutation in the LOX gene.
Meester-Loeys syndrome
MedGen UID:
934778
Concept ID:
C4310811
Disease or Syndrome
Meester-Loeys syndrome (MRLS) is an X-linked disorder characterized by early-onset aortic aneurysm and dissection. Other recurrent findings include hypertelorism, pectus deformity, joint hypermobility, contractures, and mild skeletal dysplasia (Meester et al., 2017).
Autosomal recessive cutis laxa type 2D
MedGen UID:
1376619
Concept ID:
C4479409
Disease or Syndrome
Autosomal recessive cutis laxa type IID (ARCL2D) is characterized by generalized skin wrinkling with sparse subcutaneous fat and dysmorphic progeroid facial features. Most patients also exhibit severe hypotonia as well as cardiovascular and neurologic involvement (summary by Van Damme et al., 2017). For a general phenotypic description and a discussion of genetic heterogeneity of autosomal recessive cutis laxa, see ARCL1A (219100).
VISS syndrome
MedGen UID:
1794165
Concept ID:
C5561955
Disease or Syndrome
VISS syndrome is a generalized connective tissue disorder characterized by early-onset thoracic aortic aneurysm and other connective tissue findings, such as aneurysm and tortuosity of other arteries, joint hypermobility, skin laxity, and hernias, as well as craniofacial dysmorphic features, structural cardiac defects, skeletal anomalies, and motor developmental delay (Van Gucht et al., 2021). Immune dysregulation has been observed in some patients (Ziegler et al., 2021).
Aortic aneurysm, familial thoracic 12
MedGen UID:
1802657
Concept ID:
C5676959
Disease or Syndrome
Familial thoracic aortic aneurysm-12 (AAT12) is characterized by dilation of the arterial wall associated with a progressive loss of its ability to withstand the wall tension generated by high intraluminal pressure, which can lead to intramural or complete acute vessel wall rupture. Some patients have dolichostenomelia (summary by Elbitar et al., 2021). For a general phenotypic description and a discussion of genetic heterogeneity of thoracic aortic aneurysm, see AAT1 (607086).
Cardiac valvular dysplasia 2
MedGen UID:
1823999
Concept ID:
C5774226
Disease or Syndrome
Cardiac valvular dysplasia-2 (CVDP2) is characterized primarily by congenital stenosis and insufficiency of the semilunar valves, although mild insufficiency of the atrioventricular valves has been observed as well. Other features include subaortic stenosis and dilation of the ascending aorta and/or pulmonary artery in some patients (Wunnemann et al., 2020; Massadeh et al., 2020). For a discussion of genetic heterogeneity of CVDP, see CVDP1 (212093).
Autoinflammatory disease, systemic, with vasculitis
MedGen UID:
1841161
Concept ID:
C5830525
Disease or Syndrome
Systemic autoinflammatory disease with vasculitis (SAIDV) is an autosomal dominant disorder that manifests soon after birth with features such as purpuric skin rash, fever, hepatosplenomegaly, and elevated C-reactive protein (CRP; 123260). Laboratory studies may show leukocytosis, thrombocytopenia, and autoantibodies. A subset of patients develop progressive liver involvement that may result in fibrosis. Other systemic features, such as periorbital edema, conjunctivitis, infections, abdominal pain, and arthralgia are usually observed. Mutations occur de novo. De Jesus et al. (2023) referred to this disorder as LAVLI (LYN kinase-associated vasculopathy and liver fibrosis).

Professional guidelines

PubMed

Kalogerakos PD, Zafar MA, Li Y, Ellauzi H, Mukherjee SK, Ziganshin BA, Rizzo JA, Elefteriades JA
Eur J Cardiothorac Surg 2024 May 3;65(5) doi: 10.1093/ejcts/ezae162. PMID: 38632077
Spanos K, Nana P, von Kodolitsch Y, Behrendt CA, Kouvelos G, Panuccio G, Athanasiou T, Matsagkas M, Giannoukas A, Detter C, Kölbel T
J Endovasc Ther 2022 Oct;29(5):667-677. Epub 2021 Dec 7 doi: 10.1177/15266028211061271. PMID: 34873944
Dudzinski DM, Isselbacher EM
Curr Cardiol Rep 2015 Dec;17(12):106. doi: 10.1007/s11886-015-0655-z. PMID: 26468124

Recent clinical studies

Etiology

Kalogerakos PD, Zafar MA, Li Y, Ellauzi H, Mukherjee SK, Ziganshin BA, Rizzo JA, Elefteriades JA
Eur J Cardiothorac Surg 2024 May 3;65(5) doi: 10.1093/ejcts/ezae162. PMID: 38632077
Rizza A, Negro F, Mandigers TJ, Palmieri C, Berti S, Trimarchi S
Int J Environ Res Public Health 2023 Feb 24;20(5) doi: 10.3390/ijerph20054094. PMID: 36901105Free PMC Article
Carvalho Guerra N, Velho T, Sena A, Nobre Â
Port J Card Thorac Vasc Surg 2023 Jan 14;29(4):71. doi: 10.48729/pjctvs.323. PMID: 36640281
Galian-Gay L, Rodríguez-Palomares J, Guala A, Michelena HI, Evangelista A
Prog Cardiovasc Dis 2020 Jul-Aug;63(4):442-451. Epub 2020 Jun 9 doi: 10.1016/j.pcad.2020.06.003. PMID: 32531300
Ramlawi B, Little SH, Shah D
Methodist Debakey Cardiovasc J 2011 Jul-Sep;7(3):39-42. doi: 10.14797/mdcj-7-3-39. PMID: 21979126

Diagnosis

Kalogerakos PD, Zafar MA, Li Y, Ellauzi H, Mukherjee SK, Ziganshin BA, Rizzo JA, Elefteriades JA
Eur J Cardiothorac Surg 2024 May 3;65(5) doi: 10.1093/ejcts/ezae162. PMID: 38632077
Spanos K, Nana P, von Kodolitsch Y, Behrendt CA, Kouvelos G, Panuccio G, Athanasiou T, Matsagkas M, Giannoukas A, Detter C, Kölbel T
J Endovasc Ther 2022 Oct;29(5):667-677. Epub 2021 Dec 7 doi: 10.1177/15266028211061271. PMID: 34873944
Galian-Gay L, Rodríguez-Palomares J, Guala A, Michelena HI, Evangelista A
Prog Cardiovasc Dis 2020 Jul-Aug;63(4):442-451. Epub 2020 Jun 9 doi: 10.1016/j.pcad.2020.06.003. PMID: 32531300
Cozijnsen L, Ter Borg EJ, Braam RL, Seldenrijk CA, Heijmen RH, Bouma BJ, Merkel PA
J Clin Rheumatol 2019 Jun;25(4):186-194. doi: 10.1097/RHU.0000000000000948. PMID: 30585999
Elsayed RS, Cohen RG, Fleischman F, Bowdish ME
Cardiol Clin 2017 Aug;35(3):331-345. Epub 2017 May 26 doi: 10.1016/j.ccl.2017.03.004. PMID: 28683905

Therapy

Spanos K, Nana P, von Kodolitsch Y, Behrendt CA, Kouvelos G, Panuccio G, Athanasiou T, Matsagkas M, Giannoukas A, Detter C, Kölbel T
J Endovasc Ther 2022 Oct;29(5):667-677. Epub 2021 Dec 7 doi: 10.1177/15266028211061271. PMID: 34873944
Dalman RL, Wanhainen A, Mani K, Modarai B
J Intern Med 2020 Jul;288(1):23-37. Epub 2020 Mar 18 doi: 10.1111/joim.13042. PMID: 32187752
Hongku K, Dias NV, Sonesson B, Resch TA
J Cardiovasc Surg (Torino) 2016 Dec;57(6):784-805. Epub 2016 Sep 21 PMID: 27654102
Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA
JAMA 2016 Aug 16;316(7):754-63. doi: 10.1001/jama.2016.10026. PMID: 27533160
Ramlawi B, Little SH, Shah D
Methodist Debakey Cardiovasc J 2011 Jul-Sep;7(3):39-42. doi: 10.14797/mdcj-7-3-39. PMID: 21979126

Prognosis

Gencpinar T, Topak R, Alatas O, Gulcu A, Bayrak S, Erdal C
Braz J Cardiovasc Surg 2022 Mar 10;37(1):29-34. doi: 10.21470/1678-9741-2020-0223. PMID: 33656829Free PMC Article
Kim HH, Lee S, Lee SH, Youn YN, Yoo KJ, Joo HC
J Thorac Cardiovasc Surg 2022 Aug;164(2):463-474.e4. Epub 2021 Jan 19 doi: 10.1016/j.jtcvs.2020.12.110. PMID: 33597100
Gallego-Colon E, Yosefy C, Cherniavsky E, Osherov A, Khalameizer V, Piltz X, Pery M, Bruoha S, Jafari J
J Cardiothorac Surg 2021 Apr 23;16(1):108. doi: 10.1186/s13019-021-01488-w. PMID: 33892751Free PMC Article
Sievers HH, Rylski B, Czerny M, Baier ALM, Kreibich M, Siepe M, Beyersdorf F
Interact Cardiovasc Thorac Surg 2020 Mar 1;30(3):451-457. doi: 10.1093/icvts/ivz281. PMID: 31755925
Akin I, Kische S, Rehders TC, Schneider H, Ince H, Nienaber CA
Herz 2011 Sep;36(6):539-47. doi: 10.1007/s00059-011-3500-1. PMID: 21887531

Clinical prediction guides

Li Y, Ren P, Dawson A, Vasquez HG, Ageedi W, Zhang C, Luo W, Chen R, Li Y, Kim S, Lu HS, Cassis LA, Coselli JS, Daugherty A, Shen YH, LeMaire SA
Circulation 2020 Oct 6;142(14):1374-1388. Epub 2020 Oct 5 doi: 10.1161/CIRCULATIONAHA.120.046528. PMID: 33017217Free PMC Article
Nemec P, Pepper J, Fila P
Interact Cardiovasc Thorac Surg 2020 Sep 1;31(3):342-345. doi: 10.1093/icvts/ivaa111. PMID: 32761056
Galian-Gay L, Rodríguez-Palomares J, Guala A, Michelena HI, Evangelista A
Prog Cardiovasc Dis 2020 Jul-Aug;63(4):442-451. Epub 2020 Jun 9 doi: 10.1016/j.pcad.2020.06.003. PMID: 32531300
Sievers HH, Rylski B, Czerny M, Baier ALM, Kreibich M, Siepe M, Beyersdorf F
Interact Cardiovasc Thorac Surg 2020 Mar 1;30(3):451-457. doi: 10.1093/icvts/ivz281. PMID: 31755925
Caspary L
Vasa 2016 Jan;45(1):17-29. doi: 10.1024/0301-1526/a000491. PMID: 26986706

Recent systematic reviews

Howard C, Sheridan J, Picca L, Reza S, Smith T, Ponnapalli A, Calow R, Cross O, Iddawela S, George M, Livra Dias D, Srinivasan A, Munir W, Bashir M, Idhrees M
J Card Surg 2021 Oct;36(10):3820-3830. Epub 2021 Jul 26 doi: 10.1111/jocs.15827. PMID: 34310731
Wang C, von Segesser LK, Maisano F, Ferrari E
Eur J Cardiothorac Surg 2021 Jan 4;59(1):80-91. doi: 10.1093/ejcts/ezaa238. PMID: 32893292
Muetterties CE, Menon R, Wheatley GH 3rd
J Vasc Surg 2018 Jan;67(1):332-342. Epub 2017 Aug 23 doi: 10.1016/j.jvs.2017.06.099. PMID: 28844469
Aschacher T, Salameh O, Enzmann F, Messner B, Bergmann M
Int J Mol Sci 2017 Dec 21;19(1) doi: 10.3390/ijms19010003. PMID: 29267201Free PMC Article
Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA
JAMA 2016 Aug 16;316(7):754-63. doi: 10.1001/jama.2016.10026. PMID: 27533160

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