Ascending aorta

Segment · Intrapericardial Aortic sinuses

First segment, about 5 cm long, running from the aortic valve upward and to the right inside the fibrous pericardium to the level of the sternal angle, where it becomes the arch. Its only branches are the two coronary arteries from the aortic sinuses.

Detail

Level: Begins at the aortic orifice (3rd left costal cartilage); ends at the sternal angle (T4/T5)
Branches: Right and left coronary arteries only
Relations: Pulmonary trunk to its left, SVC to its right; shares a sleeve of serous pericardium with the pulmonary trunk

When it goes wrong

Stanford type A dissection (intimal tear in the ascending aorta in a hypertensive or Marfan patient with tearing chest pain radiating to the back)

Retrograde extension can shear the right coronary ostium (inferior STEMI), disrupt the valve ring (new early diastolic murmur of aortic regurgitation) or rupture into the pericardium (tamponade); needs emergency surgery, not just blood-pressure control

Aortic root aneurysm (Marfan syndrome, bicuspid aortic valve)

Dilatation of the root stretches the valve ring, producing aortic regurgitation; dissection risk rises with root diameter

Practise this structure

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