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Ascending aorta aneurysms are commonly seen in patients with cardiovascular risk factors such as poorly treated hypertension, and hyperlipidemia (as a consequence of inflammation) in patients with a bicuspid aortic valve or in connective tissue disease or multisystem vasculitis disorders. Aortic ectasia is also described in patients undergoing valve replacement and in patients with an aortic stenosis; a poststenotic aneurysm formation can occur. Toxic substances such as cocaine and amphetamines can also lead to aortic wall thinning and aneurysm formation. An important cause of pseudo-aneurysm formation is related to trauma [1]. Hypertension, wall thinning and aortic enlargement are the most important factors in increasing wall stress, and lead to aortic rupture or dissection. Smoking increases the growth rate by 15–20%. Aortic diameter is a marker of risk. Aortic aneurysm is silent as long as there are no complications [2]. Aortic regurgitation is a typical consequence of ascending aortic aneurysm formation caused by an aortic ring dilatation with or without valve degeneration; aortic regurgitation may even be the first sign of the aneurysm formation [3]. Elective surgery has been recommended for aneurysm of the ascending aorta beyond 50 mm, in patients with a bicuspid aortic valve or an increase of 0.5 cm/year, 55–60 mm in atherosclerotic and connective tissue diseases [4].

Giant atherosclerotic ascending aortic aneurism