13th March 2024

Management

The management of aortic dilation in adults is dependent on the aortic diameter. If this is < 4.5cm (or < 4 cm in women of reproductive age), a beta blocker such as metoprolol should be commenced to prevent further dilation and reduce the risk of aortic dissection. Where betablockade is contraindicated, an angiotensin-II receptor antagonist, e.g., losartan, may be used. Calcium channel blockers are not first-line in the treatment of aortic dilation as there is evidence suggesting they may increase the risk of aortic complications.

Monitoring for aortic dilation is typically through the use of echocardiogram and MRI. Should a patient develop symptomatic thoracic aortic dilation or a type A aortic dissection, then urgent surgery is required.

Where the aortic diameter is 4.5cm or more, surgery should be considered, and this is typically valve-sparing aortic root replacement or a composite valve graft. 

Surgery may also be considered in those with aortic diameter <4.5cm if there is a high risk of dissection, such as increase in aortic diameter of at least 3 mm/year; a family history of aortic dissection, if the patient is pregnant or of reproductive age. After surgical intervention, patients will typically require long-term beta blockade. 

Mitral valve repair is indicated for severe mitral regurgitation (grade 4 or more) or with evidence of haemodynamic compromise. Those who have undergone a valve graft with a replacement mechanical valve will need long-term anticoagulation. 

While there is an increased risk of developing infective endocarditis in people with valve replacement, routine antibiotic prophylaxis is not recommended for dental procedures.