scholarly journals Ascending Aortic Length and Its Association With Type A Aortic Dissection

2021 ◽  
Author(s):  
Daniella Eliathamby ◽  
Mariana Gutierrez ◽  
Aileen Liu ◽  
Maral Ouzounian ◽  
Thomas L. Forbes ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Control Group ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Dissection ◽  
Thoracic Aneurysms

Background The aim of this study was to determine the role of ascending aortic length and diameter in type A aortic dissection. Methods and Results Computed tomography scans from patients with acute type A dissections (n=51), patients with proximal thoracic aortic aneurysms (n=121), and controls with normal aortas (n=200) were analyzed from aortic annulus to the innominate artery using multiplanar reconstruction. In the control group, ascending aortic length correlated with diameter ( r 2 =0.35, P <0.001), age ( r 2 =0.17, P <0.001), and sex ( P <0.001). As a result of immediate changes in aortic morphology at the time of acute dissection, predissection lengths and diameters were estimated based on models from published literature. Ascending aortic length was longer in patients immediately following acute dissection (median, 109.7 mm; interquartile range [IQR], 101.0–115.1 mm), patients in the estimated predissection group (median, 104.2 mm; IQR, 96.0–109.3 mm), and patients in the aneurysm group (median, 107.0 mm; IQR, 99.6–118.7 mm) in comparison to controls (median, 83.2 mm; IQR, 74.5–90.7 mm) ( P <0.001 all comparisons). The diameter of the ascending aorta was largest in the aneurysm group (median, 52.0 mm; IQR, 45.9–58.0 mm), followed by the dissection group (median, 50.3 mm; IQR, 46.6–57.5 mm), and not significantly different between controls and the estimated predissection group (median, 33.4 mm [IQR, 30.7–36.7 mm] versus 35.2 mm [IQR, 32.6–40.3 mm], P =0.09). After adjustment for diameter, age, and sex, the estimated predissection aortic lengths were 16 mm longer than those in the controls and 12 mm longer than in patients with nondissected thoracic aneurysms. Conclusions The length of the ascending aorta, after adjustment for age, sex, and aortic diameter, may be useful in discriminating patients with type A dissection from normal controls and patients with nondissected thoracic aneurysms.

scholarly journals Aggrecan: a new biomarker for acute type A aortic dissection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karl C. König ◽  
Harald Lahm ◽  
Martina Dreßen ◽  
Stefanie A. Doppler ◽  
Stefan Eichhorn ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Troponin T ◽  
Type A ◽  
Aortic Aneurysms ◽  
Aortic Tissue ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Potential Biomarker ◽  
Aortic Pathology ◽  
Creatine Kinase Mb

AbstractAcute type A aortic dissection (ATAAD) constitutes a life-threatening aortic pathology with significant morbidity and mortality. Without surgical intervention the usual mortality rate averages between 1 and 2% per hour. Thus, an early diagnosis of ATAAD is of pivotal importance to direct the affected patients to the appropriate treatment. Preceding tests to find an appropriate biomarker showed among others an increased aggrecan (ACAN) mRNA expression in aortic tissue of ATAAD patients. As a consequence, we investigated whether ACAN is a potential biomarker for diagnosing ATAAD. Mean ACAN protein concentration showed a significantly higher plasma concentration in ATAAD patients (38.59 ng/mL, n = 33) compared to plasma of patients with thoracic aortic aneurysms (4.45 ng/mL, n = 13), patients with myocardial infarction (11.77 ng/mL, n = 18) and healthy volunteers (8.05 ng/mL, n = 12). Cardiac enzymes like creatine kinase MB and cardiac troponin T showed no correlation with ACAN levels in ATAAD patients. Receiver-operator characteristics (ROC) curve analysis for ATAAD patients versus control subjects an optimum discrimination limit of ACAN plasma levels at 14.3 ng/mL with a corresponding sensitivity of 97% and specificity of 81%. According to our findings ACAN is a reliable potential biomarker in plasma samples to detect ATAAD with high sensitivity and specificity.

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

Acute Type A Aortic Dissection After TAVR in an Octogenarian With Ascending Aorta Aneurysm

2021 ◽  
Author(s):  
Helen Hashemi ◽  
Sahil Khera ◽  
Malcolm Anastasius ◽  
Ismail El-Hamamsy ◽  
Gilbert H.L. Tang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aorta Aneurysm

scholarly journals Equations Estimating the Predissected Diameter of the Ascending Aorta for Acute Type A Aortic Dissection

2019 ◽  
Vol 108 (2) ◽  
pp. 481-490 ◽  
Author(s):  
Takashi Yamauchi ◽  
Hiroshi Takano ◽  
Toshiki Takahashi ◽  
Takafumi Masai ◽  
Masayuki Sakaki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection

Aortic elongation part II: the risk of acute type A aortic dissection

Heart ◽  
2018 ◽  
Vol 104 (21) ◽  
pp. 1778-1782 ◽  
Author(s):  
Samuel Heuts ◽  
Bouke P Adriaans ◽  
Suzanne Gerretsen ◽  
Ehsan Natour ◽  
Rein Vos ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Propensity Scores ◽  
Three Dimensional ◽  
Type A ◽  
Prophylactic Surgery ◽  
Control Group ◽  
Acute Type ◽  
Healthy Controls ◽  
Cross Sectional ◽  
Type A Aortic Dissection

ObjectivesProphylactic surgery for prevention of acute type A aortic dissection (ATAAD) is reserved for patients with an ascending aortic aneurysm ≥55 mm. Identification of additional risk predictors is warranted since over 70% of patients presenting with ATAAD have a non-dilated aorta or an aneurysm that would not have met the diameter criterion for preventative surgery. Aim of the study was to evaluate ascending aortic elongation as a risk factor for ATAAD and to compare aortic lengths between ATAAD patients and healthy controls.MethodsAortic lengths and diameters of ATAAD patients were measured on three-dimensional modelled computed tomography and adjusted to predissection dimensions in this cross-sectional single-centre study. Logistic regression was used to evaluate the relation between ATAAD and aortic dimensions. Lengths of different aortic segments were compared with a healthy control group using propensity score matching.ResultsTwo-hundred and fifty patients were included in the study (ATAAD, n=40; controls, n=210). Ascending aortic length and diameter proved to be independent predictors for ATAAD (OR=5.3, CI 2.5 to 11.4, p<0.001 and OR=8.6, CI 2.4 to 31.0, p=0.001). Eighty patients were matched based on propensity scores (ATAAD n=40, controls n=40). The ascending aorta was longer and more dilated in ATAAD patients compared with healthy controls (78.6±8.8 mm vs 68.9±7.2 mm, p<0.001, 34.4 mm ±3.2. vs 39.4 mm ±5.7, p<0.001, respectively). No differences were found in lengths of the aortic arch and descending aorta.ConclusionsAscending aortic length could serve as an independent predictor for ATAAD. Future studies addressing indications for prophylactic surgery should also investigate aortic length.

scholarly journals Giant Aortic Pseudoaneurysm with Stanford Type A Aortic Dissection after Aortic Valve Replacement

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mertay Boran ◽  
Ali İhsan Parlar ◽  
Ertay Boran
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Type A Aortic Dissection ◽  
Aortic Pseudoaneurysm

Giant pseudoaneurysm of the ascending aorta is a rare but dreadful complication occurring several months or years after aortic surgery. Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture. We present a rare case of giant ascending aneurysm with Stanford type A aortic dissection occurring 6 years after aortic valve replacement and also illustrate the potential dimensions the ascending aorta may reach by a pseudoaneurysm and dissection after AVR.

scholarly journals Association of NFE2L2 Gene Polymorphisms with Risk and Clinical Characteristics of Acute Type A Aortic Dissection in Han Chinese Population

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Yiran Zhang ◽  
Qi Zheng ◽  
Ruoshi Chen ◽  
Xiaoyi Dai ◽  
Yimin Zhu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Gene Polymorphisms ◽  
Chinese Population ◽  
Clinical Characteristics ◽  
Type A ◽  
Han Chinese ◽  
Control Group ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Han Chinese Population

The present study is aimed at investigating the association of NFE2L2 gene polymorphisms with risk and clinical characteristics of acute type A aortic dissection (AAAD) in a Han Chinese population. Six SNPs (rs1806649, rs13001694, rs2364723, rs35652124, rs6721961, and rs2706110) in NFE2L2 were genotyped using SNaPshot Multiplex Kit in 94 adult patients diagnosed with AAAD at our hospital, and 208 healthy Han Chinese subjects from the 1000 Genomes Project were served as the control group. The CC genotype of rs2364723 (CC versus (GC+GG), OR = 2.069 , 95% CI: 1.222-3.502, p = 0.006 ) and CC genotype of rs35652124 (CC versus (CT+TT), OR = 1.889 , 95% CI: 1.112-3.210, p = 0.018 ) were identified as risk factors for AAAD. Multivariable linear regression analysis revealed that the CC genotype of rs2364723 ( β = 5.031 , 95% CI: 1.878-8.183, p = 0.002 ) and CC genotype of rs35652124 ( β = 4.751 , 95% CI: 1.544-7.958, p = 0.004 ) were associated with increased maximum ascending aorta diameter of AAAD. Patients carrying rs2364723 CC genotype had a higher incidence of coronary artery involvement (31% vs. 12%, p = 0.027 ), while patients carrying rs35652124 CC genotype had a higher incidence of brain ischemia (9% vs. 0%, p = 0.045 ). In conclusion, NFE2L2 gene polymorphisms were correlated with risk and severity of AAAD in Han Chinese population.

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