Ascending aortic aneurysm or dilatation, because most patients are asymptomatic, raises questions about the timing of surgery and usually requires surgical management when the diameter exceeds 5.5 cm in the absence of a family history of the disease or in the absence of aortic valve malformation. However, patients with combined Marfan’s syndrome or similar genetic disorders require aggressive surgical management when the maximum diameter of the ascending aorta is ≥5 cm. Patients with Marfan’s syndrome or other connective tissue diseases should be considered even if the maximum diameter is ≥4.5 cm if they have a combination of any of the following risk factors 1. a family history of a coarctation aneurysm of the ascending aorta; 2. a growth rate of ascending aortic diameter >2 mm per year; 3. a combination of severe aortic valve insufficiency or mitral valve insufficiency; 4. planning to become pregnant and have children.