DOES AORTIC ROOT DIAMETER PREDICT ANEURYSM OF THE ASCENDING AORTA?

The aim of our study was to compare the results of the TTE (transthoracic echocardiography) with the results obtained by the ECG-gated 64 slices CT during the followup of patients with bicuspid aortic valve (BAV), after aortic valve replacement; in particular we evaluated the aortic root and the ascending aorta looking for a new algorithm in the followup of these patients. From January 1999 to December 2009 our attention was focused on 67 patients with isolated surgical substitution of aortic valve; after dismissal they were strictly observed. During the period between May and September 2010, these patients underwent their last evaluation, and clinical exams, ECG, TTE, and an ECG-gated-MDCT were performed. At followup TTE results showed an aortic root of 36.7±4 mm and an ascending aorta of 39.6±4.8 mm. ECG- gated CT showed an aortic root of 37.9±5.5 mm and an ascending aorta of 43.1±5.2. The comparison between preoperative and postoperative TTE shows a significant long-term dilatation of the ascending aorta while the aortic root diameter seems to be stable. ECG-gated CT confirms the stability of the aortic root diameter (38.2±5.3 mm versus 37.9±5.5 mm; <0.0001) and the increasing diameter value of the ascending aorta (40.2±3.9 mm versus 43.1±5.2 mm; P=0.0156). Due to the different findings between CT and TTE studies, ECG-gated CT should no longer be considered as a complementary exam in the followup of patients with BAV, but as a fundamental role since it is a real necessity.

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Alcohol Consumption and Aortic Root Dilatation: Insights from the Corinthia Study

Angiology ◽

10.1177/0003319719848172 ◽

2019 ◽

Vol 70 (10) ◽

pp. 969-977 ◽

Cited By ~ 3

Author(s):

Evangelos Oikonomou ◽

George Lazaros ◽

Sotirios Tsalamandris ◽

Georgia Vogiatzi ◽

Evangelia Christoforatou ◽

...

Keyword(s):

Alcohol Consumption ◽

Aortic Root ◽

Root Diameter ◽

Ascending Aorta ◽

Social Drinkers ◽

Daily Alcohol Consumption ◽

Aortic Root Dilatation ◽

Study Population ◽

Group 2 ◽

Aorta Dilatation

Aortic diameter and progression to thoracic aortic aneurysm are influenced by several factors. In this study, we investigated the association of alcohol consumption with aortic root and ascending aorta dilatation. In the context of the Corinthia study, we examined 1751 patients with echocardiography. Several demographic and clinical characteristics were recorded. Alcohol consumption was assessed based on a questionnaire of frequency, type, and quantity. Accordingly, patients were categorized as everyday alcohol consumers (EDACs) and as social drinkers (SoD). Everyday alcohol consumers were further categorized to group 1: 0 to 1 drink/d; group 2: 1 to 2 drinks/d; and group 3: ≥3 drinks/d. From the study population, 40% were categorized as EDAC and had an increased aortic root diameter (AoRD) and an elevated AoRD index compared with SoD. Interestingly, there was a stepwise increase in aortic root and ascending aorta diameter according to daily alcohol consumption. Specifically, patients consuming ≥3 drinks of alcohol/d had increased indexed aortic by 1.4 mm/m2 compared with SoD even after adjustment for possible confounders. Daily alcohol consumption is associated with increased aortic root diameter. These findings may have important clinical implications, especially in patients with borderline or dilated aortic root, and merit further investigation.

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

Cardiology Research and Practice ◽

10.1155/2012/313879 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 15

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.

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

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

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.

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

The Heart Surgery Forum ◽

10.1532/hsf98.20081123 ◽

2009 ◽

Vol 12 (2) ◽

pp. E105-E108 ◽

Cited By ~ 6

Author(s):

Derek R. Brinster ◽

John D. Grizzard ◽

Alok Dash

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Aneurysmal Dilatation

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Radial self-navigated native magnetic resonance angiography in comparison to navigator-gated contrast-enhanced MRA of the entire thoracic aorta in an aortic patient collective

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00774-9 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Martina Correa Londono ◽

Nino Trussardi ◽

Verena C. Obmann ◽

Davide Piccini ◽

Michael Ith ◽

...

Keyword(s):

Magnetic Resonance ◽

Image Quality ◽

Magnetic Resonance Angiography ◽

Thoracic Aorta ◽

Aortic Root ◽

Aortic Disease ◽

Ascending Aorta ◽

Scan Time ◽

Contrast Enhanced

Abstract Background The native balanced steady state with free precession (bSSFP) magnetic resonance angiography (MRA) technique has been shown to provide high diagnostic image quality for thoracic aortic disease. This study compares a 3D radial respiratory self-navigated native MRA (native-SN-MRA) based on a bSSFP sequence with conventional Cartesian, 3D, contrast-enhanced MRA (CE-MRA) with navigator-gated respiration control for image quality of the entire thoracic aorta. Methods Thirty-one aortic native-SN-MRA were compared retrospectively (63.9 ± 10.3 years) to 61 CE-MRA (63.1 ± 11.7 years) serving as a reference standard. Image quality was evaluated at the aortic root/ascending aorta, aortic arch and descending aorta. Scan time was recorded. In 10 patients with both MRA sequences, aortic pathologies were evaluated and normal and pathologic aortic diameters were measured. The influence of artifacts on image quality was analyzed. Results Compared to the overall image quality of CE-MRA, the overall image quality of native-SN-MRA was superior for all segments analyzed (aortic root/ascending, p < 0.001; arch, p < 0.001, and descending, p = 0.005). Regarding artifacts, the image quality of native-SN-MRA remained superior at the aortic root/ascending aorta and aortic arch before and after correction for confounders of surgical material (i.e., susceptibility-related artifacts) (p = 0.008 both) suggesting a benefit in terms of motion artifacts. Native-SN-MRA showed a trend towards superior intraindividual image quality, but without statistical significance. Intraindividually, the sensitivity and specificity for the detection of aortic disease were 100% for native-SN-MRA. Aortic diameters did not show a significant difference (p = 0.899). The scan time of the native-SN-MRA was significantly reduced, with a mean of 05:56 ± 01:32 min vs. 08:51 ± 02:57 min in the CE-MRA (p < 0.001). Conclusions Superior image quality of the entire thoracic aorta, also regarding artifacts, can be achieved with native-SN-MRA, especially in motion prone segments, in addition to a shorter acquisition time.

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Echocardiographic Measurement of Aortic Root Diameter

Japanese Heart Journal ◽

10.1536/ihj.17.465 ◽

1976 ◽

Vol 17 (4) ◽

pp. 465-470 ◽

Cited By ~ 3

Author(s):

Kotaro FURUKAWA ◽

Junichi YOSHIKAWA ◽

Kumeo TANAKA ◽

Chujiro TANAKA ◽

Seiki KAWAI ◽

...

Keyword(s):

Aortic Root ◽

Root Diameter ◽

Echocardiographic Measurement

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Geometric changes in aortic root replacement using Freestyle prosthesis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01583-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Anja Osswald ◽

Alina Zubarevich ◽

Arian Arjomandi Rad ◽

Robert Vardanyan ◽

Konstantin Zhigalov ◽

...

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Aortic Annulus ◽

Strongly Correlated ◽

Root Volume ◽

Concomitant Surgery ◽

Valve Size ◽

Operative Planning ◽

Geometric Changes

Abstract Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

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

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.03.035 ◽

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

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Serial Assessment of Ductus Arteriosus Hemodynamics in Hyaline Membrane Disease

PEDIATRICS ◽

10.1542/peds.98.6.1149 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1149-1153

Author(s):

Ernest Z. Phillipos ◽

Murray A. Robertson ◽

Paul J. Byrne

Keyword(s):

Clinical Outcome ◽

Linear Relationship ◽

Aortic Root ◽

Left Atrial ◽

Ductus Arteriosus ◽

Hyaline Membrane Disease ◽

Root Diameter ◽

Shunt Volume ◽

Hyaline Membrane ◽

The Mean

Objectives. To assess the efficacy of Doppler echocardiography (DE) in the quantification of patent ductus arteriosus (PDA) shunt volume and to correlate PDA shunt volume with clinical outcome in infants with hyaline membrane disease. Methods. Ninety-eight DE studies were performed in 30 preterm ventilated infants with hyaline membrane disease within the first 24 hours of age and then at 48-hour intervals to a maximum of three studies while ventilated with a final study after extubation. Right and left ventricular outputs (QRV and QLV, respectively) and PDA flow were calculated using cross-sectional area and flow velocity integrals. Left atrial-to-aortic root diameter measurements were also taken. Clinical outcomes were correlated with the shunt fraction (QLV/QRV). Results. QLV/QRV demonstrated a linear relationship with the left atrial-to-aortic root diameter ratio (n = 92; r = .79). In the absence of a PDA (n = 33 studies), QRV versus QLV demonstrated a linear relationship (r = .88). In the presence of a PDA (n = 64 studies) the mean QLV (334 ± 133 ml/kg per minute) was significantly greater than the mean QRV (237 ± 84 ml/kg per minute). There was a linear relationship between QLV - QRV (PDA shunt volume) and PDA flow (n = 60; r = .84). In studies with exclusive left-to-right shunting at the PDA (n = 48), the mean QLV - QRV (112 ± 83 ml/kg per minute) was significantly higher than in those with bidirectional shunting (n = 16; mean QLV - QRV = 50 ± 27 ml/kg per minute). Two infants with severe intraventricular hemorrhage (IVH grade 3) and two infants with periventricular leukomalacia (PVL) had significantly higher QLV/QRV (2.09 ± 0.36 and 1.67 ± 0.02 respectively) than those with no IVH (n = 6; QLV/QRV = 1.31 ± 0.18) or those with IVH grades 1 and 2 (n = 8; QLV/QRV = 1.48 ± 0.27). There was no difference in QLV/QRV in infants with or without bronchopulmonary dysplasia retinopathy of prematurity. Necrotizing enterocolitis did not develop in any of the 30 infants. Conclusion. PDA shunt volume can be quantified by DE. Larger studies are needed to correlate clinical outcome with QLV/QRV.

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