M26 How Does the Histology of the Aortic Root and Ascending Aorta Affect Aortic Aneurysm Progression and Surgical Repair?

2021 ◽  
Vol 30 ◽  
pp. S11
Author(s):  
T. Surman ◽  
D. O'Rourke ◽  
J. Finnie ◽  
K. Reynolds ◽  
J. Edwards ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Root ◽  
Surgical Repair ◽  
Ascending Aorta

scholarly journals Using Machine Learning to Elucidate the Spatial and Genetic Complexity of the Ascending Aorta

2021 ◽  
Author(s):  
Mahan Nekoui ◽  
James Pirruccello ◽  
Paolo Di Achille ◽  
Seung Hoan Choi ◽  
Samuel Friedman ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Aortic Aneurysm ◽  
Aortic Stenosis ◽  
Aortic Root ◽  
Thoracic Aortic Aneurysm ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Uk Biobank ◽  
Polygenic Score

Background The left ventricular outflow tract (LVOT) and ascending aorta are spatially complex, with distinct pathologies and embryologic origins. Prior work examined genetics of thoracic aortic diameter in a single plane. We sought to elucidate the genetic basis for the diameter of the LVOT, the aortic root, and the ascending aorta. Methods We used deep learning to analyze 2.3 million cardiac magnetic resonance images from 43,317 UK Biobank participants. We computed the diameters of the LVOT, the aortic root, and at six locations in the ascending aorta. For each diameter, we conducted a genome-wide association study and generated a polygenic score. Finally, we investigated associations between these polygenic scores and disease incidence. Results 79 loci were significantly associated with at least one diameter. Of these, 35 were novel, and a majority were associated with one or two diameters. A polygenic score of aortic diameter approximately 13mm from the sinotubular junction most strongly predicted thoracic aortic aneurysm in UK Biobank participants (n=427,016; HR=1.42 per standard deviation; CI=1.34-1.50, P=6.67x10-21). A polygenic score predicting a smaller aortic root was predictive of aortic stenosis (n=426,502; HR=1.08 per standard deviation; CI=1.03-1.12, P=5x10-6). Conclusions We detected distinct common genetic loci underpinning the diameters of the LVOT, the aortic root, and at several segments in the ascending aorta. We spatially defined a region of aorta whose genetics may be most relevant to predicting thoracic aortic aneurysm. We further described a genetic signature that may predispose to aortic stenosis. Understanding the genetic contributions to the diameter of the proximal aorta may enable identification of individuals at risk for life-threatening aortic disease and facilitate prioritization of therapeutic targets.

Aortic aneurysm: thoracic aortic aneurysm—therapeutic options

ESC CardioMed ◽  
2018 ◽  
pp. 2573-2575
Author(s):  
Axel Haverich ◽  
Andreas Martens
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Treatment ◽  
Aortic Arch ◽  
Aortic Root ◽  
Treatment Strategies ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Long Term Results ◽  
Descending Aorta

Surgical treatment of thoracic aortic aneurysms has to account for anatomical location, patient risk profile, and the surgeon’s experience. Whereas endovascular treatment of the descending aorta has become a valid option for most patients and pathologies, open surgery remains the first choice to treat aneurysms of the aortic root, ascending aorta, and aortic arch and to treat patients with connective tissue disease in elective settings. Minimal invasive access is more frequently used to treat the aortic root, ascending aorta, and proximal aortic arch with excellent results. Long-term results of valve-sparing aortic root replacement undermine the recommendation to preserve the aortic valve, especially in young patients with tricuspid aortic valves. Aortic annulus stabilization either via valve reimplantation or external stabilization techniques in addition to aortic root remodelling ensures stable long-term results. Aortic root replacement using valved conduits remains a durable treatment option. Aortic arch surgery has been revolutionized by multiple technical solutions that facilitate surgical techniques (e.g. branched prefabricated grafts), extend treatment into the proximal descending aorta (e.g. frozen elephant trunk procedure), and minimize organ damage (e.g. cardiac and lower body perfusion during aortic arch repair). If endovascular treatment of the descending and thoracoabdominal aorta is not feasible, open surgical methods remain the standard of care and should routinely include protection methods to preserve organ function (e.g. left heart bypass, partial bypass). Treatment strategies in all patients should be discussed within a dedicated interdisciplinary team. Strict follow-up is mandatory.

Case 5.19

2014 ◽  
pp. 278-279
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Ascending Aortic Aneurysm ◽  
Hemiazygos Vein ◽  
History Of

67-year-old woman with a history of bicuspid aortic valve and ascending aortic aneurysm Axial (Figure 5.19.1) and coronal (Figure 5.19.2) fat-suppressed SSFP images show midline orientation of the liver and the absence of a spleen. The IVC is also absent, with a prominent hemiazygos vein in the abdomen and azygos and hemiazygos veins in the lower chest. The aortic root and ascending aorta are dilated....

scholarly journals Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Christian D. Etz ◽  
Martin Misfeld ◽  
Michael A. Borger ◽  
Maximilian Luehr ◽  
Elfriede Strotdrees ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Surgical Repair ◽  
Heart Association ◽  
Root Diameter ◽  
Ascending Aorta ◽  
Aggressive Approach ◽  
Asymptomatic Patients ◽  
Elective Repair

Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45 mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50 mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ≥45 mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ≥50 mm, or if the aneurysm is rapidly progressing (rate of 5 mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated—or ectatic—ascending aorta.

scholarly journals Diagnosis of a pericardial effusion with a thoracic aortic aneurysm by point-of-care ultrasound

CJEM ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 71-74
Author(s):  
Mario Francispragasam ◽  
Jeff H. Yoo ◽  
Tong V. Lam ◽  
Daniel J. Kim
Keyword(s):  
Pericardial Effusion ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Surgical Repair ◽  
Aortic Rupture ◽  
Point Of Care ◽  
Ascending Aorta ◽  
Point Of Care Ultrasound ◽  
Rule Out

AbstractWe present a rare case of a young patient with chest pain whose ascending thoracic aortic aneurysm (TAA) was detected by point-of-care ultrasound (POCUS) leading to a successful surgical repair. POCUS identified a moderate pericardial effusion and an associated severely dilated ascending aorta. In this context, it is important to rule out aortic rupture and aortic dissection. We also discuss the epidemiology, complications, and management of TAAs as well as the role of cardiac POCUS in the diagnosis of thoracic aneurysmal disease.

Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1106-1115 ◽  
Author(s):  
Hao Chen ◽  
Thomas Fink ◽  
Xianzhang Zhan ◽  
Minglong Chen ◽  
Lars Eckardt ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Right Atrium ◽  
Surgical Repair ◽  
Clinical Course ◽  
Interventional Cardiology ◽  
Ascending Aorta ◽  
Transseptal Puncture ◽  
The Right

Aims Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP. Methods and results All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure. Conclusion Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.

Valve-Sparing Replacement of the Aortic Root for a 2-year-old Child with Loeys-Dietz Syndrome

2009 ◽  
Vol 20 (1) ◽  
pp. 94-96 ◽  
Author(s):  
Yoshio Ootaki ◽  
Minhaz Uddin ◽  
Ross M. Ungerleider
Keyword(s):  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Marfan’S Syndrome ◽  
Marfan's Syndrome ◽  
Valve Sparing

AbstractLoeys-Dietz syndrome is a newly recognized constellation that presents with aortic aneurysm or dissection similar to Marfan’s syndrome. We describe successful surgical treatment in a 2-year-old with the syndrome in whom we performed a valve-sparing replacement of the aortic root because of significant dilation of the aortic root and the ascending aorta.

Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Westhoff-Bleck ◽  
Meyer ◽  
Lotz ◽  
Tutarel ◽  
Weiss ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Aortic Valve ◽  
Pulmonary Artery ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

Lupus Aortitis Leading to Aneurysmal Dilatation in the Aortic Root and Ascending Aorta

2009 ◽  
Vol 12 (2) ◽  
pp. E105-E108 ◽  
Author(s):  
Derek R. Brinster ◽  
John D. Grizzard ◽  
Alok Dash
Keyword(s):  
Aortic Root ◽  
Ascending Aorta ◽  
Aneurysmal Dilatation

Late Presentation of Penetrating Ulcers at the Ascending Aorta Associated With Intra-Mural Haematoma

2020 ◽  
Vol 3 (2) ◽  
pp. 01-05
Author(s):  
Ayman Kenawy
Keyword(s):  
High Risk ◽  
Disease Progression ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Late Presentation ◽  
Ascending Aorta ◽  
Chronic Type ◽  
Penetrating Aortic Ulcer ◽  
Good Outcome ◽  
Pseudo Aneurysm

The combined pathology of intra-mural haematoma (IMH) and penetrating aortic ulcer (PAU) represents disease progression of the PAU with high risk for further progression to either rupture or pseudo-aneurysm formation, and hence surgical intervention should be offered once diagnosis is made regardless of the presentation. We present a 70-year-old fit lady with chronic type A IMH associated with multiple PAUs, diagnosed incidentally, the patient underwent urgent surgical repair with good outcome.

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