Ascending aorta

Last revised by Jeremy Jones on 20 Mar 2024

The ascending aorta is the first part of the aorta and begins at the sinotubular junction (the junction of the aortic root and ascending aorta) and terminates as it exits the fibrous pericardium where it becomes the aortic arch, in the transthoracic plane (of Ludwig). It is located obliquely just to the left of the midline at the level of the third intercostal space.

Gross anatomy

The ascending aorta normally only has two branches, the right coronary artery and the left coronary artery. Technically, these usually arise from the aortic root from the right and left aortic sinuses of Valsalva. They are, along with the non-coronary sinus, out-pouchings of the aortic wall above each cusp of the aortic valve. Immediately above the three aortic sinuses, the normal tubular configuration of the aorta is attained at the sinotubular junction.

The ascending aorta ascends slightly towards the right of midline where it can be seen as part of the mediastinal outline on a chest radiograph. This should only be the case in the older ectatic or dilated artery. In a young patient, a prominent ascending aorta, especially when combined with signs of left ventricular hypertrophy should raise suspicion of aortic stenosis.

With the pulmonary trunk, the ascending aorta is invested in a common sheath of serous visceral pericardium, anterior to the transverse pericardial sinus.

Related pathology

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