A Dilated Ascending Aorta in a 68-Year-Old Competitive Cyclist

A 68-year-old endurance cyclist presented after an ascending aortic aneurysm was identified incidentally on a non-contrast lung cancer screening computed tomography (CT). The ascending aorta measured 4.8 cm. He noted no exertional chest pain or change in fitness. He previously participated in cycling races but more recently had been riding with friends at a moderate pace. He was cycling 150-200 miles/week, over 5-6 rides. He was also walking and doing strength training. Past medical history was notable for hypertension (managed with valsartan and hydrochlorothiazide) and dyslipidemia. Family history was notable for an ascending aortic aneurysm in his older sister.

The patient measured 1.85m in height and 100.2kg in weight with a body mass index (BMI) of 29.2kg/m2 and a body surface area of 2.27m2. Blood pressure was 134/83mmHg. Physical exam was unremarkable without joint laxity, chest, or spinal deformity, facial, oral, or ocular abnormalities. His cardiovascular exam was normal with no murmurs.

A CT angiogram (CTA) of the chest, abdomen and pelvis was performed. The aorta at sinuses of Valsalva was 4.5 cm, the ascending aorta was 4.8 cm, and a small abdominal aortic aneurysm measured 3.2 cm (Figure 1). By transthoracic echo, his aortic root was 4.5 cm (Z-score 2.63); the aortic valve was trileaflet with mild aortic insufficiency and no stenosis.  Left ventricular size, thickness, and function were normal.

Figure 1A: Aortic Root Dilatation

Figure 1A

Figure 1B: Upper Ascending and Descending Aortic Dilatation

Figure 1B

Which ONE of the following is true?

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