skip to main content

Marfan Aortic Surgery Threshold — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardGeneral Internal MedicineMarfan Aortic Surgery ThresholdRACP Adult Medicine

A 35-year-old with Marfan syndrome has an aortic root diameter of 4.7 cm and a first-degree relative who dissected at 4.8 cm. Serial imaging shows 4 mm growth in one year. What management is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Refer now to an experienced aortic surgical team because high-risk features justify repair below the usual 5.0-cm threshold

The best answer is “Refer now to an experienced aortic surgical team because high-risk features justify repair below the usual 5.0-cm threshold”. Elective root replacement is generally considered around 5.0 cm in Marfan syndrome, but rapid growth and a family history of dissection at a smaller diameter support intervention from about 4.5 cm in an expert centre. Five-year surveillance is unsafe during rapid growth, medical therapy does not remove structural risk, and routine endovascular repair is not the standard prophylactic approach to the root.

Reference: Heart Foundation: Australian clinical guidelines and position statements: https://www.heartfoundation.org.au/for-professionals/clinical-guidelines-position-statements ACC/AHA: 2022 aortic disease guideline: https://www.acc.org/Guidelines/Guidelines/2022/11/02/14/08/Aortic-Disease