Ascending aorta

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The ascending aorta is the first part of the aorta, starting at the upper part of the left ventricle just behind the left side of the breastbone. It rises upward, forward, and a little to the right for about 5 cm, staying behind the sternum for a short distance, and then becomes the aortic arch at the sinotubular junction.

Aortic root and sinuses: The aortic root runs from the aortic valve to the sinotubular junction. The three sinuses of Valsalva sit behind the valve cusps.

Branches: The only arteries that branch directly from the ascending aorta are the coronary arteries (left and right), which supply the heart.

Bulb: At the junction with the arch, the right wall forms a slight bulge called the bulb of the aorta.

Location and relations: The ascending aorta is wrapped by the pericardium. In front it is near the pulmonary trunk; behind it rests on the left atrium and right pulmonary artery. On the right side it lies near the superior vena cava and right atrium; on the left side it is near the pulmonary artery.

Size and disease: Normal diameter varies with age and sex. A diameter over about 3.5 cm is considered enlarged, and over about 4.5 cm is called an aneurysm (upper normal limits can be around 4.3 cm in some older adults).

Porcelain aorta: Severe calcification of the ascending aorta (porcelain aorta) can make surgery more difficult and riskier.

Dissection risk: The ascending aorta is prone to dissection (a tear in the wall). Early detection is important. Doctors use echocardiography, MRI, and CT with contrast to diagnose problems in this area.