Thoracic Aortic Disease 2010 Pocket Guide

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ACC/AHA Pocket Guideline

Based on the 2010 ACCF/AHA/AATS/ ACR/ASA/SCA/SCAI/SIR/STS/SVM

Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

March 2010

Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

March 2010

Writing Committee

Loren F. Hiratzka, MD, Chair George L. Bakris, MD Joshua A. Beckman, MD, MS Robert M. Bersin, MPH, MD Vincent F. Carr, DO Donald E. Casey, Jr, MD, MPH, MBA Kim A. Eagle, MD Luke K. Hermann, MD Eric M. Isselbacher, MD Ella A. Kazerooni, MD, MS Nicholas T. Kouchoukos, MD Bruce W. Lytle, MD Dianna M. Milewicz, MD, PhD David L. Reich, MD Souvik Sen, MD, MS Julie A. Shinn, RN, MA, CCRN Lars G. Svensson, MD, PhD David M. Williams, MD

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? 2010 American College of Cardiology Foundation and American Heart Association, Inc.

The following material was adapted from the 2010 ACCF/AHA/ AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary (J Am Coll Cardiol 2010;55:1509? 44). This pocket guideline is available on the World Wide Web sites of the American College of Cardiology () and the American Heart Association (my.).

For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail: reprints@; phone: 212-633-3813; fax: 212-633-3820.

Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier's permission department at healthpermissions@.

Contents

1. Introduction.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2. Critical Issues.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

3. Recommendations for Aortic Imaging Techniques to Determine the Presence and Progression of Thoracic Aortic Disease.. . . . . . . 14

4. Recommendations for Genetic Syndromes.. . . . . . . . . . . . . . . . . . . . 18

5. Recommendations for Familial Thoracic Aortic Aneurysms and Dissections.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

6. Recommendations for Bicuspid Aortic Valve and Associated Congenital Variants in Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

7. Recommendations for Estimation of Pretest Risk of Thoracic Aortic Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

8. Initial Evaluation and Management of Acute Thoracic Aortic Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 8.1. Recommendations for Screening Tests.. . . . . . . . . . . . . . . . . . 34 8.2. Recommendations for Diagnostic Imaging Studies. . . . . . . 35 8.3. Recommendations for Initial Management. . . . . . . . . . . . . . 36 8.4. Recommendations for Definitive Management. . . . . . . . . . 37

9. Recommendation for Surgical Intervention for Acute Thoracic Aortic Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

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10. Recommendation for Intramural Hematoma Without Intimal Defect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

11. Recommendation for History and Physical Examination for Thoracic Aortic Disease.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

12. Recommendation for Medical Treatment of Patients With Thoracic Aortic Diseases.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 12.1. Recommendations for Blood Pressure Control.. . . . . . . . . . . 44

13. Recommendations for Asymptomatic Patients With Ascending Aortic Aneurysm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

14. Recommendation for Symptomatic Patients With Thoracic Aortic Aneurysm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

15. Recommendations for Open Surgery for Ascending Aortic Aneurysm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

16. Recommendations for Aortic Arch Aneurysms.. . . . . . . . . . . . . . . . . 52

17. Recommendations for Descending Thoracic Aorta and Thoracoabdominal Aortic Aneurysms.. . . . . . . . . . . . . . . . . . . . . . . . . 54

18. Recommendations for Counseling and Management of Chronic Aortic Diseases in Pregnancy.. . . . . . . . . . . . . . . . . . . . . . . . . 56

19. Recommendations for Aortic Arch and Thoracic Aortic Atheroma and Atheroembolic Disease.. . . . . . . . . . . . . . . . . . . . . . . . 58

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