Aortic Aneurysm Repair Threshold — RACP Adult Medicine MCQ

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ModerateCardiologyAortic Aneurysm Repair ThresholdRACP Adult Medicine

A 65-year-old man with known ascending aortic aneurysm (52 mm on serial echo, stable over 2 years) has a bicuspid aortic valve. He has no connective tissue disorder. He is asymptomatic. What is the diameter threshold for prophylactic surgical repair?

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Correct answer: D — 55 mm

For ascending aortic aneurysm with bicuspid aortic valve, ESC 2024/CSANZ recommend surgical repair at ≥55 mm (or ≥50 mm with additional risk factors: family history of aortic dissection, rapid growth >3 mm/year, significant aortic regurgitation, or planned AVR). For Marfan syndrome: lower threshold of ≥50 mm (or ≥45 mm with risk factors). For Loeys-Dietz/vascular EDS: even lower thresholds. This patient at 52 mm with BAV but no additional risk factors should continue surveillance.

Reference: ESC – 2024 – Aortic Disease; CSANZ 2024; ACC/AHA 2024