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

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.

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

The Heart Surgery Forum ◽

10.1532/hsf.4065 ◽

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.

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

Aorta ◽

10.1055/s-0040-1701529 ◽

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.

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Ascending Thoracic Aorta Exhibits Anisotropic Failure Behavior in Shear Lap Testing

Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotransport Phenomena; Bone, Joint and Spine Mechanics; Brain Injury; Cardiac Mechanics; Cardiovascular Devices, Fluids and Imaging; Cartilage and Disc Mechanics; Cell and Tissue Engineering; Cerebral Aneurysms; Computational Biofluid Dynamics; Device Design, Human Dynamics, and Rehabilitation; Drug Delivery and Disease Treatment; Engineered Cellular Environments ◽

10.1115/sbc2013-14413 ◽

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.

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Ascending aorta mechanics in bicuspid aortopathy: controversy or fact?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320928731 ◽

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.

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Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

10.5772/996 ◽

2011 ◽

Cited By ~ 1

Keyword(s):

Aortic Arch ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Diagnosis And Treatment ◽

Thoracic Aortic Aneurysms

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Abstract 16806: Changes in Wall Stress in Ascending Thoracic Aortic Aneurysms From Systole to Diastole

Circulation ◽

10.1161/circ.142.suppl_3.16806 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Andrew Liu ◽

Zhongjie Wang ◽

Yue XUAN ◽

Michael D Hope ◽

Liang Ge ◽

...

Keyword(s):

Computer Aided Design ◽

Cardiac Cycle ◽

Aortic Rupture ◽

Wall Stress ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Patient Specific ◽

Imaging Data ◽

Element Analysis ◽

Thoracic Aortic Aneurysms

Introduction: Aortic rupture or dissection of ascending thoracic aortic aneurysms (aTAA) is a life-threatening pathology that can occur when wall stress exceeds wall strength. Surgical guidelines for repair is when aneurysm max diameter ≥5.5 cm. However, rupture has been documented at various sizes, including 60% <4.5cm. Wall stress may be a better predictor of dissection than diameter, using finite element analysis (FEA) of patient-specific aTAA models to assess patient-specific risk of dissection. The purpose of this study was to determine changes in aneurysm FEA peak wall stresses in patients during the cardiac cycle from systole to diastole. Methods: Preoperative aTAA patients (n = 20) underwent ECG-gated computed tomography (CT) scans at systolic and diastolic phases. Patient-specific 3D aneurysm geometries were reconstructed from the imaging data at both phases and after accounting for pre-stress, underwent FEA using LS-DYNA solver. Wall stress distribution and magnitude were determined using user-defined fiber-embedded material model at systole (120mmHg) and diastole (80mmHg). Aortic volume changes during the cardiac cycle were determined using computer-aided design tools. Results: From the diastolic model, the 99 th percentile circumferential stresses were 348.8 ±105.6 kPa and 186.6 ±31.4 kPa for the sinus and ascending aorta respectively, while for the systolic model, they were 500.7 ±183.7 kPa (p=0.00072) and 296.5 ±64.4 kPa (p < .00001), respectively. The 99th percentile longitudinal stresses from the diastolic model were 223.2 ±75.4 kPa and 126.1 ±20.4 kPa for the sinus and ascending aorta, respectively, while for the systolic model, they were 336.3 ±78.4 kPa (p < .00001), and 235.2 ±48.0 kPa (p < .00001), respectively. Mean volume change of the ascending aorta in percentage between systolic and diastolic phases was 6.34%. Conclusions: Peak circumferential and longitudinal stresses changed significantly from systole to diastole. For patients with significant hypertension, these differences in wall stress may be magnified such that sudden or significant hypertension may result in wall stress values that exceed tissue strength leading to dissection.

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Isolated aortic dilation without osteoarthritis: a case of SMAD3 mutation

Cardiology in the Young ◽

10.1017/s1047951118000082 ◽

2018 ◽

Vol 28 (5) ◽

pp. 765-767 ◽

Cited By ~ 3

Author(s):

Jose Arroyave ◽

Juan Manuel Carretero ◽

Domenico Gruosso

Keyword(s):

Connective Tissue ◽

Aortic Root ◽

Early Onset ◽

Autosomal Dominant ◽

Ascending Aorta ◽

Aortic Aneurysms ◽

Aortic Dilation ◽

Arterial Tree ◽

Thoracic Aortic Aneurysms ◽

Almost All

AbstractAneurysm–osteoarthritis syndrome is a recently discovered inherited autosomal dominant connective tissue disease caused by SMAD3 mutations. Aneurysm–osteoarthritis syndrome is responsible for 2% of familial thoracic aortic aneurysms and dissections and is characterised by aneurysms, dissections, and tortuosity throughout the arterial tree in combination with osteoarthritis. Early-onset osteoarthritis is present in almost all patients. We present the case of a non-syndromic young boy with SMAD3 mutation isolated from the dilated aortic root and ascending aorta without osteoarthritis.

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