Your question about when we operate, at what size, is a very
important one. We use 5.5 cm as our criterion for the ascending
aorta; we use 6.5 cm for the descending, because of the corresponding
observed sizes at the time of aortic events. We use a
smaller size of 5 cm for the ascending aorta in patients with
Marfan or those with a family history. When we take the aortic
history in the office, it is impressive how often we get an
affirmative response. We inquire, have you had any family
members who died prematurely or suddenly or of unexpected
cardiac death? The reply is positive very commonly. We consider
patients with a family history or a suspected family history
to have a connective tissue disorder, and we operate on them
earlier, just like our patients with Marfan syndrome. So 5.5 cm is
what we use without Marfan syndrome or a family history, and
5.0 cm for the ascending in case of Marfan syndrome or a
positive family history.