Porcelain Ascending Aorta

Porcelain ascending aorta (PA) is an extensive circumferential or near circumferential calcification of the ascending aorta extending to the aortic arch. Chest computed tomography (CT) is the most effective method to diagnose calcification of the thoracic aorta and PA. Two independent processes lead to the formation of aortic calcification: atherosclerosis involving the intima and calcification of the medial layer in the absence of atheroma. Both processes have separate but overlapping pathophysiology and clinical associations. There is growing evidence that identification of ascending aortic and/or aortic arch calcification can also be related independently to higher risk of cardiovascular events and mortality. Patients with PA undergoing conventional cardiac surgery require procedural modifications to attenuate neuroembolic risk and safe aortic entry and closure. Transcatheter aortic valve replacement (TAVR) is a safe and efficient option for patients with severe symptomatic aortic stenosis (AS) and PA. Routine use of chest CT for the assessment of PA in the work-up of all patients evaluated before cardiac surgery or transcatheter valve implantations may help elucidate the true incidence and clinical implications of PA.