Aorta

The aortic annulus should be measured at midsystole from inner edge to inner edge. All other aortic root measurements (i.e., maximal diameter of the sinuses of Valsalva, the sinotubular junction, and the proximal ascending aorta) should be made at end-diastole, in a strictly perpendicular plane to that of the long axis of the aorta using the leading edge-to-leading edge (L-L) convention.

Aortic root dimensions in normal adults

Aortic root MALEFEMALE
Annulus (mm)26 ± 323 ± 2
Annulus/BSA (mm/m²)13 ± 113 ± 1
Sinus of Valsalva (mm)34 ± 330 ± 3
Sinus of Valsalva/BSA (mm/m²)17 ± 218 ± 2
Sinotubular junction (mm)29 ± 326 ± 3
Sinotubular junction/BSA (mm/m²)15 ± 215 ± 2
Proximal ascending aorta (mm)30 ± 427 ± 4
Proximal ascending aorta (mm/m²)15 ± 216 ± 3
Anatomy of aorta

Ascending aorta dilation

Evaluation aortic dissection

Checklist
Location of dissection
Type A (involvement of ascending aorta)
Type B (no involvement of ascending aorta)
Location of intimal tear
Location of re-entry and possibly another tear
Involvement of aortic arch and outgoing vessels
Differentiation between true and false lumen
Involvement of coronary arteries
Presence of aortic valve insufficiency
Pericardial effusion
LV function

Classification of aortic dissection

Differentiation between true and false lumen

Differentiation
In M-mode moves the flap to the false lumen in systole.
Spontaneous echo contrast and thrombus can be seen in the false lumen.
On color Doppler, flow is shown slower systolic by secondary or re-entry to tear the false lumen.
The false lumen (especially in chronic dissections) tends to be larger in comparison to the true lumen.

Evaluation of coarctation aortae

ParameterInstrumentcommentary
LocationColor dopplerWith the origin of the carotid and subclavian artery are landmarks for locating the coarctation.
Velocity profileContinuous waveRemember that collateral will reduce the systolic speed but the diastolic gradient persists. In the presence of diastolic forward flow is spoken of a hemodynamically significant coarctation.
Typically CW Doppler signal of descending aorta with diastolic forward flow fitting in hemodynamically significant coarctation

JASE 2015 Jan;28(1):1-39.e14

European Heart Journal (2014) 35, 2873?2926