Ascending Thoracic Aorta Exhibits Anisotropic Failure Behavior in Shear Lap Testing

2013 ◽  
Author(s):  
Colleen Witzenburg ◽  
Sachin Shah ◽  
Hallie P. Wagner ◽  
Janna Goodrich ◽  
Victor H. Barocas
Keyword(s):  
Arterial Pressure ◽  
Mechanical Behavior ◽  
Thoracic Aorta ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Failure Behavior ◽  
Thoracic Aortic Aneurysms ◽  
Wall Strength ◽  
Imminent Death ◽  
Aneurysm Dissection

Aneurysm dissection and rupture, resulting in imminent death, is the primary risk associated with thoracic aortic aneurysms (TAA). Nearly 60% of TAA involves the ascending aorta [1]. Dissection and rupture occur when the remodeled tissue is no longer able to withstand the stresses generated by the arterial pressure. As the ascending TAA grows, however, changes in its mechanical behavior, particularly wall strength, are unknown.

Cannulation of the Ascending Aorta in Left Thoracotomy for Thoracic Aortic Aneurysms

2007 ◽  
Vol 10 (1) ◽  
pp. E81-E83 ◽  
Author(s):  
Riza Turkoz ◽  
Oner Gulcan ◽  
Orhan Demirturk ◽  
Ayda Turkoz
Keyword(s):  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Left Thoracotomy ◽  
Thoracic Aortic Aneurysms

scholarly journals Comparison of 10 murine models reveals a distinct biomechanical phenotype in thoracic aortic aneurysms

2017 ◽  
Vol 14 (130) ◽  
pp. 20161036 ◽  
Author(s):  
C. Bellini ◽  
M. R. Bersi ◽  
A. W. Caulk ◽  
J. Ferruzzi ◽  
D. M. Milewicz ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Structural Integrity ◽  
Ascending Aorta ◽  
Elastic Fibre ◽  
Cytoskeletal Proteins ◽  
Aortic Aneurysms ◽  
Genetic Mutations ◽  
Murine Models ◽  
Thoracic Aortic Aneurysms ◽  
Signalling Molecules

Thoracic aortic aneurysms are life-threatening lesions that afflict young and old individuals alike. They frequently associate with genetic mutations and are characterized by reduced elastic fibre integrity, dysfunctional smooth muscle cells, improperly remodelled collagen and pooled mucoid material. There is a pressing need to understand better the compromised structural integrity of the aorta that results from these genetic mutations and renders the wall vulnerable to dilatation, dissection or rupture. In this paper, we compare the biaxial mechanical properties of the ascending aorta from 10 murine models: wild-type controls, acute elastase-treated, and eight models with genetic mutations affecting extracellular matrix proteins, transmembrane receptors, cytoskeletal proteins, or intracellular signalling molecules. Collectively, our data for these diverse mouse models suggest that reduced mechanical functionality, as indicated by a decreased elastic energy storage capability or reduced distensibility, does not predispose to aneurysms. Rather, despite normal or lower than normal circumferential and axial wall stresses, it appears that intramural cells in the ascending aorta of mice prone to aneurysms are unable to maintain or restore the intrinsic circumferential material stiffness, which may render the wall biomechanically vulnerable to continued dilatation and possible rupture. This finding is consistent with an underlying dysfunctional mechanosensing or mechanoregulation of the extracellular matrix, which normally endows the wall with both appropriate compliance and sufficient strength.

scholarly journals Giant Aortic Aneurysm in Child with Cutis Laxa Syndrome: Unusual Presentation, New Surgical Technique

2021 ◽  
Vol 24 (6) ◽  
pp. E1054-E1056
Author(s):  
Mazen Shamsaldeen Faden ◽  
Nada Ahmed Noaman ◽  
Osman Osama Osman Osama ◽  
Ahmed Abdelrahman Elassal ◽  
Arwa Mohammed Al-ghamdi ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
Ascending Aorta ◽  
Accurate Diagnosis ◽  
Aortic Aneurysms ◽  
Cutis Laxa ◽  
Descending Aorta ◽  
Aorta Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Valvular Insufficiency ◽  
New Surgical Technique

Ascending thoracic aortic aneurysms are rare in childhood and typically are seen in the setting of connective tissue defect syndromes. These aneurysms may lead to rupture, dissection, or valvular insufficiency, so root replacement is recommended. Here, we present a 17-month-old girl who presented with fever, cough, and pericardial effusion. Initially, we suspected this could be a COVID-19 case, so a nasopharyngeal swap was performed. An ascending aorta aneurysm involving the aortic arch was confirmed by echo, and urgent ascending aorta and arch replacement were done by utilizing the descending aorta as a new arch. The final diagnosis came with cutis laxa syndrome. In similar cases, good outcomes can be achieved with accurate diagnosis and appropriate surgical management.

scholarly journals Primary Lymphoma Presenting in an Ascending Aortic Aneurysm: A Case Report

Aorta ◽  
2020 ◽  
Vol 08 (02) ◽  
pp. 038-040
Author(s):  
Alexander M. Schurman ◽  
David Mendoza ◽  
Chris K. Rokkas
Keyword(s):  
Management Strategies ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Prior History ◽  
Primary Lymphoma ◽  
Surgical Specimen ◽  
Hematological Disorders ◽  
Thoracic Aortic Aneurysms ◽  
Asymptomatic Patients ◽  
History Of

AbstractSmall lymphocytic lymphoma (SLL) is rarely associated with thoracic aortic aneurysms. Aneurysm of the ascending aorta associated with SLL has never been reported before. We describe the case of an asymptomatic 68-year-old woman who presented with a 5.5-cm aneurysm of the ascending aorta and no prior history of hematological disorders. Following excision and repair, the surgical specimen showed infiltration of the aortic wall by lymphocytes, expressing markers consistent with SLL. While symptomatic SLL carries a poor prognosis, risk stratification tools are applied to guide management strategies in asymptomatic patients.

scholarly journals Arterial hypertension and aortic root dilatation: an unsolved mystery

2013 ◽  
pp. 6-11
Author(s):  
Alberto Milan ◽  
Francesco Tosello ◽  
Sara Abram ◽  
Ambra Fabbri ◽  
Alessandro Vairo ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Aortic Wall ◽  
Aortic Aneurysms ◽  
Published Data ◽  
Thoracic Aortic Aneurysms ◽  
Biological Variables ◽  
Aortic Root Dilatation ◽  
Active Debate

Introduction: Acute and chronic aortic syndromes are associated with substantial morbidity and mortality. Silent risk factors such as arterial hypertension and aortic root dilatation can increase the likelihood of aortic dissection or rupture. The relationship between arterial hypertension and the dimensions of the aortic root dimension is a topic of active debate. Materials and methods: We reviewed the literature on the physiopathology, diagnosis, natural history, and management of thoracic aortic aneurysms. Results: Biological variables influencing the size of the aorta include age, sex, body surface area, pressure values, and stroke volume. Pathologic enlargement of the thoracic aorta can be caused by genetic, degenerative, inflammatory, traumatic, or toxic factors. Studies investigating the correlation between aortic dimensions and arterial pressures (diastolic, systolic, or pulse) have produced discordant results. Discussion: Classically, emphasis has been placed on the importance of hypertension-related degeneration of the medial layer of the aortic wall, which leads to dilatation of the thoracic aorta, reduced aortic wall compliance, and increased pulse pressures. However, there are no published data that demonstrate unequivocally the existence of a pathogenetic correlation between arterial hypertension and aortic root dilatation. Furthermore, there is no evidence that antihypertensive therapy is effective in the management of nonsyndromic forms of aortic root dilatation. An interesting branch of research focuses on the importance of genetic predisposition in the pathogenesis of thoracic aortic aneurysms. Different genetic backgrounds could explain differences in the behaviour of aortic walls exposed to the same hemodynamic stress. Further study is needed to evaluate these focal physiopathological aspects.

Endovascular versus open treatment of degenerative aneurysms of the descending thoracic aorta: a single center experience

Vascular ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Joachim Andrassy ◽  
Rolf Weidenhagen ◽  
Georgios Meimarakis ◽  
M Rentsch ◽  
K-W Jauch ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Open Surgery ◽  
Aortic Aneurysms ◽  
Descending Thoracic Aorta ◽  
Entire Cohort ◽  
Thoracic Aortic Aneurysms ◽  
Asymptomatic Patients ◽  
Open Treatment ◽  
One Year

Multiple reports could show a reduced risk for thoracic endovascular aortic repair (TEVAR) compared with open treatment. The aim of this study was to evaluate our twelve-year TEVAR experience for thoracic aortic aneurysms and compare these results with open repair. All patients who had received either open or endovascular surgery for a degenerative aortic aneurysm of the descending thoracic aorta in our center were evaluated retrospectively. N = 53 TEVAR patients (1997–2008) were included and their course was compared with an open-surgery group of n = 24 patients (1992–2002). The percentage of symptomatic patients was 43% (TEVAR) and 42% (open surgery). Endovascular treatment resulted in a significantly reduced 30-day (5.7% versus 25% P = 0.02) and one-year mortality (19% versus 42% P = 0.05) in the entire cohort. Symptomatic patients benefited the most from TEVAR (30-day mortality: 9% versus 40%, P = 0.06; one-year mortality: 27% versus 70%, P = 0.049) whereas the survival of our asymptomatic patients was not significantly different (30-day mortality: 3% versus 14%, P = 0.22; one-year mortality: 13% versus 21%, P = 0.65). Lastly, Kaplan–Meier analysis showed a significantly improved survival after TEVAR ( P = 0.05) and in particular for the symptomatic patients ( P = 0.003). In conclusion, endovascular treatment for patients with degenerative thoracic aortic aneurysms has significant advantages over open surgery.

scholarly journals Aortic Arch Aneurysm. Compression Respiratory Complications as a Vital Indication for Emergency Surgery.

2021 ◽  
Author(s):  
Husam H. Balkhy ◽  
Roman Komarov ◽  
Vladimir Parshin ◽  
Alisher Ismailbayev ◽  
Nikolay Kurasov ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Aortic Arch ◽  
Thoracic Aorta ◽  
Emergency Surgery ◽  
Giant Aneurysm ◽  
Community Acquired Pneumonia ◽  
Pulmonary Complications ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Risk Of Rupture

Abstract Background: giant thoracic aortic aneurysms and aortic arch dissections are accompanied by high mortality rates, cardiac and neurologic events and pulmonary complications. Aorta-tracheal fistula and tracheobronchial compression are formidable and well-known complications of aneurysms of the thoracic aorta. Twenty-two percent of aneurysms that size >6 cm are ruptured with 80% mortality rate.Case presentation: a 56-year-old man with severe multivascular coronary artery injury and giant aneurysm of ascending aorta and aortic arch, complicated by respiratory failure and recurrent community-acquired pneumonia. Preoperative chest CT showed giant partially-thrombosed ampullary false aneurysm of ascending aorta, aortic arch and initial part of the thoracic aorta, 80x100x65 mm in size. Patient successfully underwent simultaneous surgical intervention with artificial blood circulation, the total time of cardiopulmonary bypass was 190 minutes.Conclusions: tracheobronchial compression syndrome with the aortic arch aneurysms is one of the urgent conditions that needs emergency surgery. Urgent indications for surgery in such cases include both significant size of the aneurysm and high risk of rupture, as well as potential for developing critical respiratory failure and recurrent nonresolving pneumonias. Preoperative CT enables to find out the exact location and evaluate the degree of airway compression, which determines further intraoperative actions. We recommend to use bronchoscopy at all steps of treatment of such patients, from intubation in operating room to extubation in intensive care unit. Thus, aggressive surgical tactics along with careful pre-operative diagnostic are the key to success and the only chance for such patients.

Robotic Replacement of the Descending Thoracic Aorta: An Alternative to Endovascular Therapy?

2006 ◽  
Vol 1 (3) ◽  
pp. 115-118
Author(s):  
Eyal E. Porat ◽  
Peter D. Herrera ◽  
Roy Sheinbaum ◽  
Anthony L. Estrera ◽  
Tam T.T. Huynh ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Lung Ventilation ◽  
Aortic Aneurysms ◽  
Added Value ◽  
Long Term Results ◽  
Dacron Graft ◽  
Descending Thoracic Aorta ◽  
Thoracic Aortic Aneurysms

Background Replacement of the descending thoracic aorta is traditionally performed via a left thoracotomy. Endovascular treatment of descending thoracic aortic aneurysms has recently evolved as an alternative treatment for selected patients, yet no long-term results are available. The authors replaced the descending thoracic aorta in a group of pigs with an interposition Dacron graft using a closed-chest, totally robotic technique. Methods Ten pigs, weighing 25 to 45 kg, underwent surgery using the DaVinci robotic surgical system. Under single-lung ventilation and CO2 insufflation, the descending thoracic aorta was completely mobilized. Proximal and distal cross-clamps were applied through separate accessory stab wounds. The mid-descending thoracic aorta was excised. An interposition Dacron graft was robotically sewn in an end-to-end fashion to the descending thoracic aorta using interrupted nitinol clips. Results All animals survived the procedure. Mean aortic clamp time was 55 ± 14 minutes. All anastomoses were completed without difficulty with a mean total anastomotic time of 42 ± 11 minutes. The anastomoses were challenged for bleeding by administrating α1-adrenergic receptor agonists to a systolic blood pressure of 200 mm Hg with no evidence of leak. Discussion Robotic replacement of the thoracic aorta is feasible and reproducible. This procedure provides the standard Dacron graft repair with its known long-term results. The added value of robotic technology to the therapeutic armamentarium in the treatment of thoracic aortic aneurysms may be worth the effort required for procedural development. Furthermore, it may serve as a valid alternative to endovascular treatment of thoracic aortic aneurysms.

Ascending aorta mechanics in bicuspid aortopathy: controversy or fact?

2020 ◽  
pp. 021849232092873
Author(s):  
Dimitrios C Iliopoulos ◽  
Dimitrios P Sokolis
Keyword(s):  
Mechanical Properties ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Aortic Dilatation ◽  
Aged Patients ◽  
Thoracic Aortic Aneurysms ◽  
Maximal Diameter ◽  
Sole Criterion

Bicuspid aortic valve is the most common congenital cardiovascular defect, often associated with proximal aortic dilatation, and the ideal management strategy is debated. The inconsistency in previous and present guideline recommendations emphasizes the insufficiency of the maximal diameter as the sole criterion for prophylactic repair. Our ability to guide clinical decisions may improve through an understanding of the mechanical properties of ascending thoracic aortic aneurysms in bicuspid compared to tricuspid aortic valve patients and non-aneurysmal aortas, because dissection and rupture are aortic wall mechanical failures. Such an understanding of the mechanical properties has been attempted by several authors, and this article addresses whether there is a controversy in the accumulated knowledge. The available mechanical studies are briefly reviewed, discussing factors such as age, sex, and the region of mechanical examination that may be responsible for the lack of unanimity in the reported findings. The rationale for acquiring layer-specific properties is presented along with the main results from our recent study. No mechanical vulnerability of ascending thoracic aortic aneurysms was evidenced in bicuspid aortic valve patients, corroborating present conservative guidelines concerning the management of bicuspid aortopathy. Weakening and additional vulnerability was evidenced in aged patients and those with coexisting valve pathology, aortic root dilatation, hypertension, and hyperlipidemia. Discussion of these results from age- and sex-matched subjects, accounting for the region- and layer-specific aortic heterogeneity, in relation to intact wall results and histologic confirmation, helps to reconcile previous findings and affords a universal interpretation of ascending aorta mechanics in bicuspid aortopathy.

Sign in / Sign up

Export Citation Format

Share Document