Histopathological changes in dilated ascending aorta associated with aortic valve cuspidity

2020 ◽  
Author(s):  
Mikita Karalko ◽  
Vaclav Stejskal ◽  
Martin Dergel ◽  
Jan Gofus ◽  
Salifu Timbilla ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Wall ◽  
Elective Surgery ◽  
Ascending Aorta ◽  
Elastic Fibre ◽  
Aortic Diameter ◽  
Histopathological Changes ◽  
Clinical Database ◽  
Aneurysmal Dilation ◽  
Matrix Accumulation

Abstract OBJECTIVES Patients with a bicuspid aortic valve (BAV) often present with a dilated ascending aorta. However, the underlying pathogenesis for the observed changes in the aortic wall and the resulting aneurysmal dilation remains a subject of debate. This study aims to compare the histological abnormalities of the ascending aorta in BAV and tricuspid aortic valve (TAV) patients and their correlation with aortic diameter and patient age. METHODS A total of 376 patients from our institution’s clinical database were included in the retrospective analysis. These patients underwent either elective surgery for ascending aorta dilation or emergency surgery for aortic dissection, either isolated or with a structurally diseased aortic valve. After excision, the ascending aorta samples were analysed by a pathologist. RESULTS On histological examination, a higher degree of elastic fibre fragmentation and loss and mucoid extracellular matrix accumulation was present in the samples from TAV patients when compared with that from BAV patients (P < 0.001). However, correlation was poor for all variables when considering aortic diameter and histological abnormalities or age and histological abnormalities in both BAV and TAV patients. CONCLUSIONS Our study demonstrates a greater incidence of severe histological abnormalities in TAV patients when compared with BAV patients.

scholarly journals Natural history of the aortic wall changes in adults with the degenerative tricuspid aortic valve stenosis: The morphometric proofs and implications for echocardiography

2019 ◽  
Vol 76 (3) ◽  
pp. 241-258
Author(s):  
Sasa Borovic ◽  
Milica Labudovic-Borovic ◽  
Vera Todorovic ◽  
Jelena Rakocevic ◽  
Jelena Marinkovic-Eric ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Morphological Data ◽  
Histopathological Changes ◽  
Tricuspid Aortic Valve ◽  
Hemodynamic Stress ◽  
Sinus Valsalvae ◽  
Echocardiographic Parameters

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscAof more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR.

scholarly journals Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaoru Hattori ◽  
Natsuki Nakama ◽  
Jumpei Takada ◽  
Gohki Nishimura ◽  
Ryo Moriwaki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Pulsatile Flow ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Circulation System ◽  
Resonance Imaging ◽  
Left Posterior ◽  
Flow Circulation ◽  
The Right

AbstractThe characteristics of aortic valvular outflow jet affect aortopathy in the bicuspid aortic valve (BAV). This study aimed to elucidate the effects of BAV morphology on the aortic valvular outflow jets. Morphotype-specific valve-devising apparatuses were developed to create aortic valve models. A magnetic resonance imaging-compatible pulsatile flow circulation system was developed to quantify the outflow jet. The eccentricity and circulation values of the peak systolic jet were compared among tricuspid aortic valve (TAV), three asymmetric BAVs, and two symmetric BAVs. The results showed mean aortic flow and leakage did not differ among the five BAVs (six samples, each). Asymmetric BAVs demonstrated the eccentric outflow jets directed to the aortic wall facing the smaller leaflets. In the asymmetric BAV with the smaller leaflet facing the right-anterior, left-posterior, and left-anterior quadrants of the aorta, the outflow jets exclusively impinged on the outer curvature of the ascending aorta, proximal arch, and the supra-valvular aortic wall, respectively. Symmetric BAVs demonstrated mildly eccentric outflow jets that did not impinge on the aortic wall. The circulation values at peak systole increased in asymmetric BAVs. The bicuspid symmetry and the position of smaller leaflet were determinant factors of the characteristics of aortic valvular outflow jet.

scholarly journals Ascending aorta dilation in association with bicuspid aortic valve: A maturation defect of the aortic wall

2014 ◽  
Vol 148 (4) ◽  
pp. 1583-1590 ◽  
Author(s):  
Nimrat Grewal ◽  
Adriana C. Gittenberger-de Groot ◽  
Robert E. Poelmann ◽  
Robert J.M. Klautz ◽  
Johannes H.N. Lindeman ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Maturation Defect

Heart valve disease (aortic valve disease): anatomy and pathology of the aortic valve

2016 ◽  
Author(s):  
Cristina Basso ◽  
Gaetano Thiene ◽  
Siew Yen Ho
Keyword(s):  
Aortic Valve ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Distinctive Features ◽  
Aorta Aneurysm ◽  
Rheumatic Valve Disease ◽  
Relationship Of ◽  
The Relationship

The gross features of the aortic valve apparatus, consisting of three semilunar leaflets, three interleaflet triangles, three commissures, and the aortic wall, are discussed both in terms of normal and pathological anatomy. The concept of aortic annulus and the relationship of the aortic valve with the coronary arteries, the membranous septum, and conduction system and the mitral valve are addressed. When dealing with pathology, the chapter focuses on the main distinctive features of aortic valve stenosis and aortic valve incompetence. Regarding the former, the abnormalities reside in the cusps, either two or three in number, with cusp thickening, and calcification with or without commissural fusion (thus distinguishing senile and chronic rheumatic valve disease); in the latter, the gross changes can affect either the cusps (infective endocarditis with tissue perforation/laceration and rheumatic valve disease with tissue retraction) or the aortic wall (ascending aorta aneurysm either inflammatory or degenerative). The distinctive gross abnormalities in the various conditions are illustrated.

scholarly journals Identification of Aorta-Specific DNA Methylation Patterns in Cell-Free DNA from Patients with Bicuspid Aortic Valve-Associated Aortopathy and Correlation with Aortic Wall Cell Death

2020 ◽  
Author(s):  
Ashna Maredia ◽  
David Guzzardi ◽  
Mohammad Aleinati ◽  
Fatima Iqbal ◽  
Aiswarya Madhu ◽  
...  
Keyword(s):  
Cell Death ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Aortic Diameter ◽  
Tunel Staining ◽  
Chromosome 11 ◽  
Cell Free Dna ◽  
Free Dna ◽  
Wall Cell

ABSTRACTObjectiveIn a proof-of-concept study we sought to identify aorta-specific differentially methylated regions (DMRs) detectable in plasma cell-free DNA (cfDNA) obtained from patients with bicuspid aortic valve (BAV)-associated aortopathy.MethodsWe used bioinformatics and publicly-available human methylomes to identify aorta-specific DMRs. We used data from 4D-flow cardiac magnetic resonance imaging to identify regions of elevated aortic wall shear stress (WSS) in patients with BAV-associated aortopathy undergoing surgery and correlated WSS regions with aortic tissue cell death assessed using TUNEL staining. Cell-free DNA was isolated from patient plasma and levels of candidate DMRs were correlated with aortic diameter and aortic wall cell death.ResultsAortic wall cell death was not associated with maximal aortic diameter but was significantly associated with elevated WSS. We identified 24 candidate aorta-specific DMRs and selected 4 for further study. A DMR on chromosome 11 showed acceptable specificity for the aorta and correlated significantly with aortic wall cell death. Plasma levels of total and aorta-specific cfDNA did not correlate with aortic diameter.ConclusionsElevated WSS created by abnormal flow hemodynamics is associated with increased aortic wall cell death which supports the use of aorta-specific cfDNA as a potential tool to identify aortopathy and stratify patient risk.Date and Number of Institutional Review Board ApprovalREB17-0207

scholarly journals Hemodynamic Characteristics of Dilated Ascending Aorta in Patients with Bicuspid Aortic Valve

2021 ◽  
Author(s):  
Tie Zheng ◽  
Shijie Lu ◽  
Shuai Zhu ◽  
Jiafu Ou ◽  
Jun-Ming Zhu
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Numerical Models ◽  
Outer Part ◽  
Flow Patterns ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Aortic Dilatation ◽  
Distribution Features ◽  
Aortic Size

Abstract Objective: Aim of this study is to investigate the influence of aortic diameter on hemodynamic environment characteristics in patient with the bicuspid aortic valve (BAV) and dilated ascending aorta (AAo) .Methods: In this study, an MRI of one BAV patient with 4.5 cm AAo was collected and numerical model was constructed. Based on the images，the other three numerical models were constructed with different ascending aortic size with 4.0cm, 5.0cm and 5.5cm respectively while the size and the geometry of other parts were fixed. Then hemodynamics in these four models was simulated numerically and the flow patterns and loading distributions were investigated.Results: Hemodynamics environments in the AAo were simulated with different aortic size. As the aortic diameter increases, we find: 1. the blood flow becomes more disturbing;2.the wall pressure at ascending aortic is higher; 3. the wall shear stress at the ascending aortic decreases; 4.oscillatory shear index of the outer part on the proximal AAo increases;5. all these hemodynamic parameters described above are asymmetrically distributed in dilated AAo and more parts of aorta would be affected as the AAo dilatation progresses.Conclusions: The study revealed that the diameter of ascending aortic can significantly influence the magnitude and distribution of the dynamics. There are altered flow patterns, pressure difference, WSS and OSI distribution features in bicuspid aortic valve patients with vascular dilatation. As the extent of aortic dilatation increases especially exceed 5.5cm,this study support the recent guideline that aortic replacement should be considered .

scholarly journals Contributing Factor of Proximal Arch Dilation in Patients with Bicuspid Aortic Valve—Wall Shear Stress or Upward Extension of Ascending Aorta Dilation?

2020 ◽  
Vol 23 (4) ◽  
pp. E435-E440
Author(s):  
Fei Li ◽  
Qi Gao ◽  
En Qiao ◽  
Gang Yin ◽  
Ru-Jiao Zhang ◽  
...  
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Wall Shear Stress ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Selective Approach ◽  
Significant Difference ◽  
Wall Shear ◽  
The One

Purpose: The dilation of proximal arch (PArc) was suspected to develop as a result of valve-related hemodynamics or in consequence to the upward extension of the ascending aorta (AAo) dilation. We aimed to investigate the one that could be the possible contributing factor in patients with bicuspid aortic valve (BAV). Methods: All enrolled BAV patients underwent four-dimensional flow magnetic resonance imaging. Contour-averaged circumferential wall shear stress (WSScirc,avg) and the diameter of the middle of AAo (mid-AAo) were compared between the patients with and without PArc dilation. Additionally, we analyzed the correlation between WSScirc,avg and aortic diameter at PArc section, as well as the correlation between the diameter of mid-AAo and that of PArc. Results: No significant difference was observed in WSScirc,avg at PArc section between the patients with and without PArc dilation (P = .621). However, the diameter of mid-AAo in the patients who suffered PArc dilation was higher than those without it (P = .007). In addition, the aortic diameter did not correlate with the WSScirc,avg at PArc level (R = -0.068, P = .701). The correlation was observed between PArc diameter and mid-AAo diameter (R = 0.521, P = .002). Conclusion: Hemodynamics may not contribute to the development of PArc dilation. PArc diameter correlated with mid-AAo diameter, indicating PArc dilation may be secondary to the upward extension of AAo dilation. The influence of AAo dilation extending upward could be treated by AAo replacement; hence, a selective approach to transverse PArc replacement might be appropriate.

P6498Linkage analysis of transvalvular flow patterns, histopathology and target gene expression in aortic valve disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Gross ◽  
D Lindner ◽  
F M Ojeda ◽  
S Blankenberg ◽  
H Reichenspurner ◽  
...  
Keyword(s):  
Gene Expression ◽  
Shear Stress ◽  
Aortic Valve ◽  
Wall Shear Stress ◽  
Aortic Valve Disease ◽  
Aortic Wall ◽  
Valve Disease ◽  
Aortic Diameter ◽  
Tissue Samples ◽  
Study Population

Abstract Objectives Recent studies have shown that shear stress can alter the integrity and gene expression of the aortic wall. We aim to analyze the link between jet dynamic, histological alterations, and gene expression patterns of the proximal aorta in patients with aortic valve disease. Methods We prospectively identified a total of 139 consecutive patients who were referred for aortic valve replacement (AVR) from January 2012 through December 2015. All patients underwent pre-operative MRI assessment to determine the maximal shear stress area of the proximal aorta. Depending of the aorta diameter we subdivided our study population in three subgroup (i.e., patients with a diameter ≤40mm, 41–49mm and ≥50mm). Based on the MRI results, two aortic wall tissue samples were collected during surgery. One sample were acquired from an area of low wall shear stress (WSS) and the second from the area of maximal WSS. The samples were graded in seven histopathologic features. For RNA isolation the tissue was disrupted using a Tissue Lyser II (Qiagen). For the gene expression analysis of h18S, hCCL2, hCOL1A1, hVCAM1, and hELN reverse transcription of RNA was carried out using the High-capacity cDNA kit (life-technologies,USA). Therefore, 125 ng total RNA from tissue samples were reversely transcribed into cDNA. Results Regardless of the aortic valve functional lesion (i.e., stenosis or regurgitation), the maximal area of WSS was in the major curvature of the proximal aorta (73%, n=102). We observed that in both tissue samples just the orientation of vascular smooth muscle cell was strongly related to the diameter of the ascending aorta (p=0.004 vs. p=0.0032). In the whole study population any significant correlation was found between maximal cross-sectional aortic diameter and genes expression. However, in the subgroup analysis we identified that the tissue samples who were exposed to higher wall shear stress and presented a diameter ≥50mm, showed a statically significant gene over-expresion of COL1A1 (p=0.041) and ELN (p=0.01). In the tissue samples with a low WSS we also identified a significant over-expression of CCL2 (p=0.005) and COL1A1 (p=0.01). Conclusions Tissue samples from the slow WSS area with a proximal aortic diameter ≥50mm presented elevated levels of inflammatory response genes (i.e, CCL2). On the other hand, samples that were exposed to higher WSS demonstrated more relation to changes in the architecture of the connective fibres (i.e., elastin and collagen). Acknowledgement/Funding None

scholarly journals Development of a multivariable prediction model for patient-adjusted aortic risk morphology

2020 ◽  
Vol 58 (4) ◽  
pp. 692-699
Author(s):  
Tobias Krüger ◽  
Rodrigo Sandoval Boburg ◽  
Hasan Hamdoun ◽  
Alexandre Oikonomou ◽  
Malte N Bongers ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Dissection ◽  
Prediction Model ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Control Group ◽  
Type A Aortic Dissection ◽  
Brachiocephalic Trunk

Abstract OBJECTIVES Preventing type A aortic dissection requires reliable prediction. We developed and validated a multivariable prediction model based on anthropometry to define patient-adjusted thresholds for aortic diameter and length. METHODS We analysed computed tomography angiographies and clinical data from 510 control patients, 143 subjects for model validation, 125 individuals with ascending aorta ectasia (45–54 mm), 58 patients with aneurysm (≥55 mm), 206 patients with type A aortic dissection and 19 patients who had received a computed tomography angiography ≤2 years before they suffered from a type A aortic dissection. Computed tomography angiographies were analysed using curved planar reformations. RESULTS In the control group, the mean ascending aortic diameter was 33.8 mm [standard deviation (SD) ±5.2 mm], and the length, measured from the aortic valve to the brachiocephalic trunk, was 91.9 mm (SD ±12.2 mm); both diameter and length were correlated with anthropometric parameters and were smaller than the respective values in all pathological groups (P < 0.001). Multivariable linear regression analysis of the control group revealed that age, sex and body surface area were predictors of ascending aorta diameter (R2 = 0.40) and length (R2 = 0.26). Bicuspidity of the aortic valve was not included in the model; its prevalence was only 3.2% in the control group but >25% in the ectasia and aneurysm groups. CONCLUSIONS The regression model provides a patient-adjusted prediction of the thresholds for aortic diameter and length. In our retrospective data, the model resulted in better identification of aortas at the risk of dissection than the conventional 55-mm diameter threshold. The model is available as an Internet calculator (www.aorticcalculator.com).

P1823Aortic walls elastic properties assessment with ultrafast ultrasound imaging in case of bicuspid aortic valve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Goudot ◽  
T Mirault ◽  
C Cheng ◽  
M Gruest ◽  
J Amoah ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Ultrasound Imaging ◽  
Bicuspid Aortic Valve ◽  
Aortic Stiffness ◽  
Cardiac Cycle ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Aortic Dilatation ◽  
Sinus Of Valsalva

Abstract Background Magnetic resonance imaging allows evaluation of aortic stiffness by the maximum rate of systolic distension (MRSD) a new prognosis factor of aortic dilatation in patients with bicuspid aortic valve (BAV). MRSD requires a continuous monitoring of the aortic diameter during the cardiac cycle, not accessible to conventional echocardiography contrary to ultrafast ultrasound imaging (UF). Purpose To develop specific aortic sequences in ultrafast ultrasound imaging (UF) to provide access to the aortic MRSD Methods Tissue Doppler allowed a precise estimation of the movement of each wall and the fine variation of the aortic diameter. To automatically track the anterior and posterior aortic walls during the cardiac cycle, we developed in the laboratory a specific interface (Figure). MRSD was the maximum of the derivative of the diameter chande over time. To assess this new technique, 24 patients (10 BAV patients and 14 controls, mean age 45.8 vs. 40.7 years, p=0.464, respectively) were consecutively included at a reference center for BAV. The ascending aorta was evaluated at the sinus of Valsalva, the tubular aorta and the aortic arch with a phased array probe (Supersonic Imagine) and dedicated sequences at 2000 frames/s. Results The lab-made interface allowed to track the aortic diameter and to calculate the MRSD from the UF acquisitions for each patient. We found lower MRSD at the sinus of Valsalva in case of BAV in accordance with previously demonstrated higher stiffness at this segment by our team (Table). Table 1. UF Aortic parameters for BAV patients and controls BAV patients Controls p (Mann Whitney) Sinus of Valsalva Diameter (mm) 26.2 [22.4–32.5] 27.09 [23.5–29.5] 0.796 MRSD (s–1) 1.05 [0.73–1.19] 1.51 [1.28–1.99] 0.023 Tubular ascending aorta Diameter 31.4 [29.4–32.2] 28.9 [22.6–31.5] 0.328 MRSD 0.94 [0.59–1.27] 1.09 [0.87–1.41] 0.353 Aortic arch Diameter 24.2 [23.7–24.8] 24.2 [18.9–24.5] 0.673 MRSD 0.57 [0.35–1.07] 0.85 [0.76–1.02] 0.257 Results are median [25th–75th percentile]. Figure 1 Conclusion UF allows evaluation of aortic stiffness by MRSD using dedicated sequence and interface. As echocardiography, UF is easily accessible and therefore deserves attention from cardiologists taking care of BAV patients to evaluate the segmental aortic remodeling associated with BAV.

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