Ascending Aorta

aorta ascendens

The ascending aorta arises from the left ventricle at the aortic valve and ascends approximately 5 cm to the aortic arch. It lies within the pericardium and gives rise to the right and left coronary arteries from the right and left sinuses of Valsalva respectively. The sinuses of Valsalva are three bulges above each aortic valve leaflet — right, left, and non-coronary — that create vortex flow to prevent leaflet occlusion of the coronary ostia.

Region: Chest

Clinical Relevance

Clinical Notes

The ascending aorta is the most common site of aortic aneurysm requiring surgical intervention, with risk of rupture and dissection when the diameter exceeds 5.5 cm (or 5 cm in connective tissue disorders). Type A aortic dissection involving the ascending aorta requires emergency surgical replacement. Transcatheter aortic valve implantation (TAVI) delivers the prosthetic valve via the ascending aorta through either transfemoral or transaortic access. Calcium scoring of the ascending aorta on CT guides safe cross-clamping sites during cardiac surgery.

Pathology

Common Injuries & Conditions

Type A Aortic Dissection

Acute intimal tear involving the ascending aorta produces a Type A dissection with risk of cardiac tamponade, aortic regurgitation, coronary ostium occlusion causing MI, and stroke from innominate vessel involvement, requiring emergency ascending aortic replacement under cardiopulmonary bypass.

Ascending Aortic Aneurysm

Progressive dilation of the ascending aorta from hypertension, bicuspid aortic valve, or connective tissue disease produces aneurysm managed by regular surveillance and prophylactic surgical replacement when the diameter exceeds threshold.