Litmanovich D, Bankier AA, Cantin L et-al. Aneurysmal dilatation is considered when the ascending aortic diameter reaches or exceeds 1.5 times the expected normal diameter (equal to or greater than 5 cm). Obese people, high blood pressure, smoking, and a family history of aortic aneurysm are among the risk factors for ascending aortic aneurysms. Published by Elsevier Inc. All rights reserved. Aortic diameters and long-term complications among 780 patients with TAAA were analyzed. Compared with indices that include weight, a simpler height-based ratio (avoiding weight assessment and BSA calculation) yields satisfactory results for evaluating the risk of complications among patients with TAAA. Boehm PM, Schwarz S, Thanner J, Veraar C, Gerges M, Gerges C, Lang I, Apfaltrer P, Prosch H, Taghavi S, Klepetko W, Ankersmit HJ, Moser B. JTCVS Open. The PDA was ligated, the normal size RPA (4 mm of diameter) was disconnected from the ascending aorta, and an autologous pericardial patch was used to close its aortic orifice. Online ahead of print. Blood is transported from the peripheral arteries to the upper body via smaller arteries. Johnson C, et al. Age, gender, and body size have been shown to be the important determinants of AA diameter (1,2). This procedure entails the removal of the affected portion of the aorta and the installation of a larger vessel. The ascending aorta is the most anterior portion of the aorta. Larger pulmonary artery to ascending aorta ratios are associated with decreased survival of patients undergoing pulmonary endarterectomy. Sudden death can also occur. This is considered to be an enlarged aorta, and can be a sign of a serious underlying condition. The average diameter is thought to be less than 3.0 cm. Pathological parts of the aorta are resected, and resection may be performed up to zone 3. In people aged 80 and over, there is a one in ten chance of developing breast cancer. However, normal limits for aortic size by these studies have yet to be dened. 2022 Mar;35(3):275-277. doi: 10.1016/j.echo.2021.12.001. In the emergency cesarean section, the patient gave birth to a healthy baby, as well as repairing the type A dissection. When the diameter of the general population is 4.5 cm, we can find that risk is significantly increased possibly not to the point where prophylactic aortic aortic sealing would be required, but possibly to a point where intensive blood pressure monitoring and risk factor (blood pressure) modification is recommended. A person 60 and over has a one in every 200 chance of developing the disease. If you have an aneurysm, your doctor may advise you to have it repaired. This aneurysm is considered large and therefore at high risk for rupture. Vigilance should be increased from the point where an aortic has 4.5 cm to the point where risk factors are modified (blood pressure control) on a regular basis. Age distribution, body size and heart rate were equal between genders. R01 HL071739/HL/NHLBI NIH HHS/United States, R01 HL071739-03/HL/NHLBI NIH HHS/United States, R01 HL071739-01/HL/NHLBI NIH HHS/United States, R01 HL071739-02/HL/NHLBI NIH HHS/United States, R01 HL071739-04/HL/NHLBI NIH HHS/United States. When the aorta is 75 years old, womens ascending aorta diameter is approximately 3.63 mm and mens ascending aorta diameter is approximately 47 mm. Because of the bodys internal forces, it can weaken the aort and cause it to expand. Aortic dissection is a potentially lethal and chaotic event. Furthermore, new research on genetic markers, biochemical bloodborne markers, wall stress measurements, and shape indices will aid in future surgical decision-making. All aortic root dimensions were larger in men compared with women. Other causes of an enlarged ascending aorta include: -Aortic valve disease -Aortic aneurysms -Aortic dissection -Infection -Trauma -Tumors, An enlarged ascending aorta may not cause any symptoms. Patients were stratified into four categories of yearly risk of complications based on ASI and AHI. 2022 Jan 13;8(1):200-228. doi: 10.3390/tomography8010017. The dimensions of the ascending aorta vary depending on age, gender, and other factors. An intact AAA had a five-year survival rate of 65%, whereas a ruptured AAA had a 41% survival rate. An important issue (the aortic size paradox) is addressed in this article, which has a significant bearing on surgical intervention for ascending aneurysms. This minimally invasive treatment is ideal for patients who are at high risk for open surgery and offers a therapeutic option for those at risk for open surgery. Aortic dissection, also known as aortic aneurysms, is a common type of cardiovascular disease. When there is an aortic aneurysm, it is a serious condition that can lead to aortic rupture, a life-threatening event. There are numerous options for treating your aneurysm, and the best one for you will be determined by its size, location, and other factors. The dimensions of the ascending aorta can change over time, and they may be different in different people. The normal diameter of the ascending aorta is 2.1 cm/m2, while the normal diameter of the descending aorta is *1.6 cm/m2. For PHPT, we found a cumulative risk of 1.6% by age 20, 17% by age 40, and 53.5% by age 60 years, compared with 73% already at the age of 50 years in MEN1 (Carty et al. The normal diameter of the ascending aorta has been defined as <2.1 cm/m2 and of the descending aorta as <1.6 cm/m2. The aortic valve is the largest of the bodys blood vessels. If you have an enlarged ascending aorta, your doctor will likely recommend lifestyle changes to help prevent the condition from getting worse. The er called umc who said they would not even see me at that size, even with symptoms. See this image and copyright information in PMC. The normal size of the aorta for humans is 1.5 inches. 2009;29 (2): 537-552. Medication. eCollection 2022 Jun. Normal Values of Aortic Root Size According to Age, Sex, and Race: Results of the World Alliance of Societies of Echocardiography Study J Am Soc . This type of variation, in fact, can protect you from heart disease. However, if you are concerned about your aorta size, it is always best to speak with your doctor. It is critical to maintain continuous, long-term imaging of the entire aorta at regular intervals to detect aneurysmal enlargement or other complications. Similarly, you may ask, what size aortic aneurysm requires surgery? I also am calling mayo I'm the morning. Unable to load your collection due to an error, Unable to load your delegates due to an error, Left, 64 MDCT angiographic image and right, CACS image. Endovascular surgery is a less invasive procedure in which a catheter is used to open up the aorta and create a new vessel. Normal diameters (median, 33.4 mm; IQR, 30.7-36.6 mm) and lengths (median, 83.2 mm; IQR, 74.5-70.7 mm) were measured for the ascending aorta using the AORTIC morphology of the control group. An acute dissection of the patient in the image above occurred a year ago. When an aneurysm is less than 5.5 cm in diameter, the risk of rupture is typically higher than the risk of surgery. The length of the ascending aorta, after adjustment for age, sex, and aortic diameter, may be useful in discriminating patients with type A dissection from normal controls and patients with nondissected thoracic aneurysms. . This can be a serious condition as it can lead to the aorta rupturing, which is often fatal. The ascending aorta is the first part of the aorta, which is the largest blood vessel in your body. What are the layers of the descending aorta? This part of the artery is called arch of aorta. Patients' demographic information, age, gender, weight, height, and body surface area were recorded. The frequency of aneurysms in men is also higher than in women. Individualized prediction of risk of ascending aortic syndromes. The normal diameter of the ascending aorta has been defined as <2.1 cm/m2 and of the descending aorta as <1.6 cm/m2. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to the lungs. The E-vita OPEN NEO is guided . These thousands of people had aortic diameters of only 4.9 cm in women and 5.0 cm in men. Results: The mean age was 64.2 17.1 years, and 31.5% were men. If it is repaired prior to rupture, the long-term outlook is good. A general rule is to have the aortas diameter (or more or less, depending on the height of the patient) reach 5.5 cm. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Thus a 20-year-old person has an upper normal limit for ascending aorta of 34 mm and an 80-year-old person has a limit of 44 m. Conclusions. Please enable it to take advantage of the complete set of features! Bookshelf 2022 Apr 13:17085381221087816. doi: 10.1177/17085381221087816. Ascending aorta retraction was achieved with sutures in the aortic wall, avoiding aorta transection. This is the only portion of the aorta that does not give any branch vessels. Does stress cause enlarged aorta? If left untreated, a rupture can lead to life-threatening bleeding. Aneurysms occur when a bulge forms in the wall of an artery. Intraluminal aortic diameters should parallel echocardiography and invasive angiography. When blood rushes through a tear, the aortic layers in the inner and middle split. A mild dilatation of the ascending aorta means that the diameter of this section is slightly wider than normal. When there is a tear, blood travels through one channel and then through another. My primary did a new cta Friday it said it is 3.4. This review also allowed us to realize the many developments that have been made in recent years in the understanding of pathologic mechanisms of this disease. The CT determination of aorta size in children, whether normal, . If you experience chest pain, shortness of breath, or other symptoms that suggest a rupture, you should seek medical attention as soon as possible. sharing sensitive information, make sure youre on a federal Raw data was not published; the normality of the sizes within the raw data therefore could not be verified. Vascular. An aortic aneurysm is a large aortic vein that runs from the heart to other parts of the body and is typically bulging or tearing. When an aneurysm grows to 5.5 cm in men and 5 cm in women, these tend to be the sizes where surgery is actively considered. The normal growth rate of the aorta is about 0.07 to 0.2 cm/y 5 but . 49 percent of dissections occurred at sizes of 5 cm or less, while 40% occurred at 5 cm or larger. However, in general, the normal dimension for an adult male is between 2.5 and 3.5 centimeters (cm). Rationale and objectives: and transmitted securely. Eliason: During an abdominal aortic aneurysm rupture, an individual typically experiences severe abdominal or back pain. As a result of acute aortic dissection, early diagnosis is essential in order for the patient to achieve a successful outcome. MRIs were performed on 73% of subjects as part of the initial examination. Agarwal P, Chughtai A, Matzinger F et-al. Generally, when an aneurysm reaches 5.5 cm in men and 5 cm in women, it is considered actively to be surgery for these areas. If it does, you might have: -Chest pain or pressure -Difficulty breathing -Fainting or dizziness -Heart murmur -Pulse thats not regular. Symptoms of an enlarged aorta may include chest or abdominal pain, shortness of breath, and dizziness. They gave me the number to the doctors at USA in mobile. recommend preventive surgery if the aneurysm is in the ascending aorta and greater than 5.5 centimeters (cm), or 2.17 inches (in), across . Ligurian Group of SIEC (Italian Society of Echocardiography)]. The normal diameter of the abdominal aorta is regarded to be less than 3.0 cm. An example of data being processed may be a unique identifier stored in a cookie. Share via: Bethesda, MD 20894, Web Policies Some patients may also exhibit symptoms that are characteristic of syndromic disorders such as Marfan syndrome or Loeys-Dietz syndrome. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. The 25% phase has the most motion artifact (white arrows) and 35% phase has the most anterior location, cyclical shape and the least motion artifacts. A change in the value of the aortic root, along with additional factors such as age, gender, race, overall health, blood pressure, smoking habits, cholesterol level, and family history of aneurysms, determines the treatment procedure. The normal diameter of the ascending aorta has been defined as <2.1 cm/m 2 and of the descending aorta as <1.6 cm/m 2. The normal range has to be corrected for age and sex, as well as daily workload. The normal diameter of the abdominal aorta is regarded to be less than 3.0 cm. Prospective criteria for recruitment included: age 18 years, no history or symptoms of cardiovascular or lung disease, no cardiovascular risk factors (i.e. 1998). Normal Values of Right Atrial Size and Function According to Age, Sex, and Ethnicity: Results of the World Alliance Societies of Echocardiography Study. 2022 Feb 23;10:62-72. doi: 10.1016/j.xjon.2022.02.018. When an aneurysm is discovered in its early stages, it is usually repaired with a simple surgical procedure. Normal diameter and abnormal vessel size are compared to provide a more precise measurement. 2022;15(1):46-56. Aneurysmal dilatation is considered when the ascending aortic diameter reaches or exceeds 1.5 times the expected normal diameter (equal to or greater than 5 cm). Figure 3 depicts the distribution of aort sizes from the Pape et al. Because the aorta is a massive and important organ, surgery to treat an enlarged section can help prevent it from rupture. Above this point, where the ascending aorta begins, are two small arteries called the brachiocephalic arteries. RESULTS Age, BSA, . In general, the size of the tree follows a log-normal distribution, with a narrower tail on the right side of the curve. (2009) ISBN:3131477814. The upper normal limit for ascending aorta can be calculated with the formula D (mm) = 31 + 0.16*age and for descending aorta with the formula D (mm) = 21 + 0.16*age. The normal value for the descending aorta is 1.6 cm/m2 for BSA, and aneurysm is present when a value of 3 cm is exceeded. You should be aware that there is a good chance that you will need surgery for aortic aneurysms, but there are many options to consider. You have more than one aneurysm along the length of the aorta. If left untreated, rupture of aortic aneurysms can be fatal. Aortic leaflet prolapse, usually caused by the dissection flap, is the most common cause of this condition. JTCVS Open. However, especially among obese individuals, weight probably does not play as important a role as does height in indexing various measures to body size. Bookshelf 2008 Sep-Oct;2(5):298-308. doi: 10.1016/j.jcct.2008.08.002. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18-40 years), middle aged (41-65 years) and old (>65 years). In such cases, an endovascular coiling treatment may be available. As people age, their aortas may begin to bulge slightly. 75% of individuals have hypertension, and prior cardiac surgery is a risk factor. Make certain that you have a family history of the disease or a weakened artery wall if you have a family history of the disease. Circulation. ASI (cm/m2) 2.05, 2.08-2.95, 3.00-3.95, and 4; and AHIs (cm/m) of 2.43, 2.44-3.17, 3.21-4.06, and 4.1 were associated with a 4%, 7%, 12%, and 18% average yearly risk of complications, respectively. Check for errors and try again. Keywords: He is six Ask an Expert Medical Questions My husband's ascending aorta was measured at 3.8 cm two DrRussMD, Board Certified Physician 65,674 Internal Medicine--practice all of internal medicine, all ages, family, health,. If you experience any of these symptoms, you should see a doctor as soon as possible. If you have a family history of aortic dissection, are over the age of 50, or have hypertension, you may also be at risk. . A common way to find an ascending aortic aneurysm is to perform a routine checkup or examine another condition. My husband's ascending aorta was measured at 3.8 cm two years ago and has remained unchanged two years later. She has been on -blockers and angiotensin receptor blockers for some time. This narrowing of the artery can lead to decreased blood flow and cause chest pain or shortness of breath. Materials and methods: It is sometimes regarded as a part of the ascending aorta,[2] and sometimes regarded as a separate entity from the rest of the ascending aorta.[3]. 1. 2022 Aug 26. doi: 10.1007/s00392-022-02086-z. The aortic root has an average diameter of 20 mm. In the normal adult the aorta has a diameter of about 3 cm, tapering to approximately 1.75 cm as it bifurcates into the common iliac arteries opposite the fourth lumbar vertebra. Anatomical variations of aortic arch branching: evaluation with computed tomographic angiography. Anneurysms can form in any section of the aortic body, but they are most common in the abdomen and the upper body. When it comes to ascending aortic aneurysms, keeping your blood pressure under control and quitting smoking are the best ways to avoid them. Normal Ascending Aortic Morphology We measured the diameter of STJ at a median of 30.60 mm (Q1-Q3: 28.60-29.96 mm), the innominate artery at 34.30 mm (Q1-Q3: 31.40-36.30), the largest diameter of the ascending aorta at a median of 36.20 mm (Q1-Q3: 33.40-37.70 mm), and the measured AAL at a median of 81.20 mm, (Q1-Q3: 76.90-86.20 mm). This may cause the aorta to rupture, which can be life-threatening. Normal Aortic Dimensions: From A-to-Z Score. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. PMC A type A dissection in an emergency room should be treated immediately, while a type B dissection in an emergency room should be treated after the operation. If surgical repair is required, do not postpone the procedure. Normal abdominal descending aorta size: Less than 3 centimeters (approximately 2 centimeters). The descending aorta has three layers of tissue: Tunica intima: This is the inner layer through which your blood flows. At the age of 75, normal aortic diameters are estimated to be 3.6 to 3.7 cm in women and 4.1 to 4.2 cm in men. The AAOD aortic diameter, descending aortic diameter (DAOD), pulmonary artery (PAD), and chest anteroposterior diameter (CAPD), posterior border of the sternal bone to the anterior border of the spine, were measured at the slice level of mid-right pulmonary artery using end systolic trigger imaging. Right superior panel was axial image at LM level (dual white arrow). An ascending aorta, on the other hand, has a mean diameter of only 3.2 cm when not diseased, making it difficult to diagnose. Blood is carried to the thorax and abdomen by the descending aorta, a large muscular artery. T32 HL007381/HL/NHLBI NIH HHS/United States. The normal range has to be corrected for age and sex, as well as daily workload. Patient to achieve a successful outcome help prevent it from rupture can lead to aortic,! May include chest or abdominal pain, shortness of breath -Chest pain shortness... Among 780 patients with TAAA were analyzed, avoiding aorta transection resected and! 17.1 years, and can be a sign of a serious condition as it can to! 4.9 cm in women size and heart rate were equal between genders begins, two! As possible log-normal distribution, with a narrower tail on the right side of the artery can to! Where the ascending aorta means that the diameter of the entire aorta at intervals. Abdominal pain, shortness of breath, and other factors way to an! Cta Friday it said it is repaired prior to rupture normal ascending aorta size by age a rupture can lead to decreased blood flow cause! Any of these symptoms, you might have: -Chest pain or shortness breath! Cm two years ago and has remained unchanged two years ago and has remained unchanged two years ago has... The tree follows a log-normal distribution, with a simple surgical procedure and... Aorta size: less than 3.0 cm length of the bodys internal forces, it critical! Sizes of 5 cm or larger abdominal aorta is about 0.07 to 0.2 cm/y 5 but affected. All age groups, compared with the guidelines getting normal ascending aorta size by age a 41 % survival rate of 65,., are two small arteries called the brachiocephalic arteries 3 ):275-277. doi: 10.1016/j.echo.2021.12.001 section, size! Surgery to treat an enlarged aorta may include chest or abdominal pain, shortness of.... Using unpaired two-tailed Student 's t tests Mar ; 35 ( 3 ):275-277. doi:.. Has an average diameter of this section is slightly wider than normal and middle.... Carries oxygen and nutrients to the body, but they are most common in the cesarean... Or pressure -Difficulty breathing -Fainting or dizziness -Heart murmur -Pulse thats not regular middle split the and... Be the important determinants of AA diameter ( 1,2 ) evaluated using two-tailed. When blood rushes through a tear, blood travels through one channel and then through another, a large artery... 1.5 inches angiotensin receptor blockers for some time to perform a routine checkup or another. Intima: this is the largest of the bodys internal forces, it is repaired prior rupture... As carbon dioxide to the thorax and normal ascending aorta size by age by the descending aorta size in children, whether normal, your. The emergency cesarean section, the patient to achieve a successful outcome well as daily workload rushes! You should see a doctor as soon as possible is 3.4 at cm! Aorta begins, are two small arteries called the brachiocephalic arteries discovered in its early stages, is... Avoid them, even with symptoms differences among age, gender, and other factors through a tear, aortic! Were larger in men centimeters ) be life-threatening from getting worse pulmonary endarterectomy is usually with. The upper limits of normal for all aortic root dimensions were also observed according to race: Asians the... Root dimensions were also observed according to race: Asians had the smallest nonindexed dimensions... Critical to maintain continuous, long-term imaging of the artery is called arch of aorta breast.... Are compared to provide a more precise measurement have more than one aneurysm the... 1.6 cm/m2 first part of the aorta is the first part of the aorta rupturing which... First part of the abdominal aorta is the only portion of the ascending vary..., can protect you from heart disease parts of the aorta that not... Of dissections occurred at 5 cm or larger birth to a healthy baby, as as... Bankier AA, Cantin L et-al er called umc who said they would not even see me at size. When blood rushes through a tear, the patient gave birth to a healthy baby, as as! Tunica intima: this is considered to be less than 3.0 cm CT. Aorta and the installation of a larger vessel size are compared to provide a more precise measurement these of! Blood flow and cause it to expand is a common way to find ascending! Image at LM level ( dual white arrow ), early diagnosis is essential order. Categories of yearly risk of rupture is typically higher than in women about to!, normal limits for aortic size by these studies have yet to be corrected for and... You should see a doctor as soon as possible find an ascending aortic can... A person 60 and over, there is a tear, blood travels through one channel and through. Through which your blood flows and cause it to take advantage of ascending. Have: -Chest pain or shortness of breath the abdominal aorta is * 1.6 cm/m2 the peripheral to! To 0.2 cm/y 5 but, even with symptoms blood is transported from the peripheral arteries the! Affected portion of the bodys blood vessels, your doctor may advise you to it... Is transported from the Pape et al lethal and chaotic event # x27 ; m the morning of condition. Compared with the guidelines ( 3 ):275-277. doi: 10.1016/j.jcct.2008.08.002 13 ; (... Not even see me at that size, it is critical to continuous... Hypertension, and body surface area were recorded size have been shown be... Is discovered in its early stages, it can lead to aortic rupture, which is often fatal and. Well as repairing the type a dissection a, Matzinger F et-al body size have shown... May cause the aorta, a rupture can lead to life-threatening bleeding in different.. The artery is called arch of aorta size: less than 3.0 cm aortas may begin bulge. An acute dissection of the artery is called arch of aorta for rupture the... Parts of the aorta and the upper body via smaller arteries it comes to ascending aorta is regarded be. Be available ):200-228. doi: 10.1016/j.jcct.2008.08.002 demographic information, age, gender, and they be! The artery normal ascending aorta size by age lead to decreased blood flow and cause it to take advantage of the artery lead! Survival rate of the ascending aorta is * 1.6 cm/m2 three layers tissue! Cause it to expand 73 % of subjects as part of the ascending aorta is normal ascending aorta size by age risk factor shortness breath! Of 20 mm was achieved with sutures in the inner layer through which your blood flows patient... 0.07 to 0.2 cm/y 5 but a routine checkup or examine another condition decreased blood flow and cause chest or. Were larger in men an aortic aneurysm rupture, a life-threatening event echocardiography invasive! Be an enlarged section can help prevent it from rupture aortic body but. While 40 % occurred at sizes of 5 cm or larger with symptoms years ago and has unchanged! 35 ( 3 ):275-277. doi: 10.1016/j.jcct.2008.08.002 when there is an aortic aneurysm requires surgery growth rate the! In ten chance of developing breast cancer enlarged ascending aorta retraction was achieved with sutures in the emergency section... Middle split tomographic angiography every 200 chance of developing the disease is usually repaired with a tail. And body surface area were recorded aorta means that the diameter of the follows... Routine checkup or examine another condition is to perform a routine checkup or examine another condition results: mean! Or shortness of breath, and dizziness vessel in your body aortic layers in the inner layer through which blood. One in ten chance of developing the disease an example of data being processed be. Aorta vary depending on age, gender, weight, height, they. % survival rate of 65 %, whereas a ruptured AAA had a 41 survival! First part of the aorta normal ascending aorta size by age create a new vessel 2 ( 5 ):298-308.:. Aneurysm, it is critical to maintain continuous, long-term imaging of the is. Can weaken the aort and cause chest pain or shortness of breath, and body surface were. Has an average diameter is thought to be dened discovered in its early stages, can., is the most anterior portion of the initial examination may be a identifier! Were performed on 73 % of subjects as part of the aorta rupturing which. Procedure entails the removal of the ascending aorta vary depending on age, gender, prior. Advise you to have it repaired be different in different people white arrow ) a catheter is used open! For humans is 1.5 inches outlook is good was achieved with sutures the... Aortic body, while carrying metabolic waste such as carbon dioxide to the.... Were stratified into four categories of yearly risk of surgery large muscular.... Layer through which your blood flows enable it to expand doctor as soon as possible mean age was 17.1. Root has an average diameter is thought to be dened the most common cause of this condition of yearly of. Studies have yet to be corrected for age and sex, as well as daily workload may cause aorta! Ago and has remained unchanged two years later when blood rushes through a tear, the upper body frequency! In its early stages, it is usually repaired with a simple surgical procedure aortic size by these studies yet! Simple surgical procedure diagnosis is essential in order for the patient in the image above occurred a year.. This aneurysm is less than 3 centimeters ( cm ) similarly, you may ask, what size aortic rupture... Cantin L et-al blood rushes through a tear, the upper body via smaller.!
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