scholarly journals The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus.

2020 ◽  
Author(s):  
Timothy Luke Surman ◽  
John Matthew Abrahams ◽  
Dermot O'Rourke ◽  
Karen Reynolds ◽  
James Edwards ◽  
...  
Keyword(s):  
Aortic Root ◽  
Complex Structure ◽  
Aortic Pressure ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Pressure Testing ◽  
Risk Of Rupture ◽  
In Series ◽  
Susceptible Populations

Abstract BackgroundThe aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations.MethodsWe developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.ResultsIn the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure.ConclusionOur results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.

scholarly journals The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Timothy Luke Surman ◽  
John Matthew Abrahams ◽  
Dermot O’Rourke ◽  
Karen Jane Reynolds ◽  
James Edwards ◽  
...  
Keyword(s):  
Aortic Root ◽  
Complex Structure ◽  
Aortic Pressure ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Pressure Testing ◽  
Risk Of Rupture ◽  
In Series ◽  
Susceptible Populations

Abstract Background The aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations. Methods We developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n = 5 aortic root and n = 5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined. Results In the aortic root, mean maximal pressure (mmHg) at tissue failure was 208 mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300 mmHg without tissue failure or dissection, and eventual apparatus failure. Conclusion Our results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.

scholarly journals The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus.

2020 ◽  
Author(s):  
Timothy Luke Surman ◽  
John Matthew Abrahams ◽  
Dermot O'Rourke ◽  
Karen Reynolds ◽  
James Edwards ◽  
...  
Keyword(s):  
Aortic Root ◽  
Complex Structure ◽  
Aortic Pressure ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Pressure Testing ◽  
Risk Of Rupture ◽  
In Series ◽  
Susceptible Populations

Abstract Background The aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations. Methods We developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n=5 aortic root and n=5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.Results In the aortic root, mean maximal pressure (mmHg) at tissue failure was 208mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300mmHg without tissue failure or dissection, and eventual apparatus failure. Conclusion Our results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.

scholarly journals A Huge Aneurism of Ascending Thoracic Aorta

2021 ◽  
Vol 5 (2) ◽  
pp. 883-886
Author(s):  
Andi Kacani ◽  
Saimir Kuci ◽  
Arber Aliu ◽  
Alfred Ibrahimi ◽  
Aferdita Veseli ◽  
...  
Keyword(s):  
Aortic Root ◽  
Rare Condition ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Aorta Aneurysm ◽  
Operating Technique ◽  
Risk Of Rupture ◽  
Life Threatening ◽  
Clinical Awareness ◽  
Selection Of

Giant Ascending Aorta Aneurysm (AAA) is a rare condition, because of early diagnosis incidence appears to be increasing as a result of routine screening, increased clinical awareness, and improved imaging modalities. The etiology of aneurysms involving the aortic root and ascending aorta can be genetically triggered, degenerative or atherosclerotic, inflammatory, or can result from infectious diseases.  According to many studies for ascending aortic aneurysms larger than 6 cm the risk of rupture, dissection, or deaths was 15.6, making it a large life-threatening aneurysm. We present the case of a Giant AAA of about 8,7 cm diameter in a 68 years old man who was successfully operated on for ascending aorta and aortic root replacement under modified Bentall technique using composite mechanical conduit with coronary reimplantation. Conclusion; Ascending giant aortic aneurysm is a rare finding, varying from asymptomatic clinical presentation. Surgical treatment remains the standard treatment with very good results. The selection of the operating technique is very individual, depending on the case and the experience of the surgeon.

scholarly journals WALL STRESS IN ASCENDING AORTA ANEURYSMS AS A PREDICTIVE FACTOR OF BREAKAGE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
R J Burgos Lázaro ◽  
N Burgos Frías ◽  
S Serrano-Fiz García ◽  
V Ospina Mosquera ◽  
F Rojo Pérez ◽  
...  
Keyword(s):  
Aortic Wall ◽  
Wall Stress ◽  
Middle Layer ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Resistance Factors ◽  
Risk Of Rupture ◽  
Traction Test

Abstract INTRODUCTION The surgical indication for ascending aortic aneurysms (AAA) is established when the maximum diameter > 50 mm; It responds to Laplace's Law (T wall = P × r / 2e). The aim of the study is to define wall stress in AAA. MATERIAL AND METHODS 218 ascending aortic walls have been studied: 96 from organ donors, and 122 from AAA: Marfán 58 (47.5%), bicuspid aortic valve 26 (21.4%), and atherosclerosis 38 (31.1%). The samples were studied "in vitro", according to the model Young's (relationship between stress and deformed area), by means of the mechanical traction test (Tension = Force / Area). The analysis was performed with the stress-elongation curve (d Tension / d Elongation). RESULTS The stress of the aortic wall, classified from highest to lowest according to pathology and age was: cystic necrosis of the middle layer, arteriosclerosis, age > 60 years, between 35 and 59, and < 34 years. The stress of “control aortas” wall increased directly in relation to the age of the donors. CONCLUSIONS The maximum diameter of the ascending aorta, the patient's type of pathology and age are factors that affect the maximum tension of the aortic wall and resistance, factors that allow differentiation and prediction of the risk of rupture of the AAA. The validation of the results obtained through numerical simulation was significant and the uniaxial analysis has modeled the response of the vessels to their internal pressure.

scholarly journals Histological regional analysis of the aortic root and thoracic ascending aorta: a complete analysis of aneurysms from root to arch

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Timothy Luke Surman ◽  
John Matthew Abrahams ◽  
Jim Manavis ◽  
John Finnie ◽  
Dermot O’Rourke ◽  
...  
Keyword(s):  
Aortic Root ◽  
Regional Analysis ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Collagen I ◽  
Ultrastructural Changes ◽  
Complete Analysis ◽  
Elastin Fiber ◽  
Collagen Iii ◽  
Unique Composition

Abstract Background Although aortic root and ascending aortic aneurysms are treated the same, they differ in embryological development and pathological processes. This study examines the microscopic structural differences between aortic root and ascending aortic aneurysms, correlating these features to the macroscopic pathophysiological processes. Methods We obtained surgical samples from ascending aortic aneurysms (n = 11), aortic root aneurysms (n = 3), and non-aneurysmal patients (n = 7), Aortic collagen and elastin content were examined via histological analysis, and immunohistochemistry techniques used to determine collagen I, III, and IV subtypes. Analysis was via observational features, and colour deconvolution quantification techniques. Results Elastin fiber disruption and fragmentation was the most extensive in the proximal aneurysmal regions. Medial fibrosis and collagen density increased in proximal aneurysmal regions and aortic root aneurysms (p < 0.005). Collagen I was seen in highest quantity in aortic root aneurysms. Collagen I content was greatest in the sinus tissue regions compared to the valvular and ostial regions (p < 0.005) Collagen III and IV quantification did not vary greatly. The most susceptible regions to ultrastructural changes in disease are the proximal ascending aorta and aortic root. Conclusions The aortic root differs histologically from the ascending aorta confirming its unique composition in aneurysm pathology. These findings should prompt further evaluation on the influence of this altered structure on function which could potentially guide clinical management.

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.

scholarly journals Successful case of Benthal de Bono surgery in Cabrol modification with one-step aortic arch prosthesis and repeat coronary artery bypass surgery in a patient with de Bakey type 1 acute aortic dissection

2021 ◽  
Vol 38 (3) ◽  
pp. 153-158
Author(s):  
B. K. Kadyraliev ◽  
V. B. Arutyunyan ◽  
S. V. Kucherenko ◽  
V. N. Pavlova ◽  
E. S. Spekhova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Root ◽  
Artery Bypass ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Golden Standard ◽  
Valve Reconstruction

The ascending aortic aneurysm occurs in 45 % of cases from the total number of aortic aneurysms of various localization. The incidence rate of combination of the aortic disease with aneurysm per 100 000 of the population is 5.9. The problem of prosthetics of the aortic root and aortic valve due to aneurysm and the changed AV is rather actual. The main principle of aneurysm surgery is the prevention of the risk of dissection and rupture with reconstruction of normal dimensions of the ascending aorta. Currently, there are different techniques for the treatment of root aneurysms and ascending aorta. The standard techniques are aortic root replacement, aortic valve reconstruction with replacement of aortic root or ascending aorta and partial or full replacement of aortic arch depending on the situation. The Bentall De Bono operation at present remains a golden standard of surgical treatment of the aneurysms of the root and ascending aorta with changed aortic valve. This surgery can have the following complications: thrombotic, thromboembolic followed by conduit dysfunction, formation of false anastomosis aneurysms, hemorrhage, compression of coronary artery orifices due to tension in the zone of coronary anastomoses.

Partial Aortic Root Remodeling in Case of Ascending Aortic Aneurysms

2013 ◽  
Vol 8 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Fabrizio Sansone ◽  
Edoardo Zingarelli ◽  
Fabrizio Ceresa ◽  
Francesco Patanè
Keyword(s):  
Aortic Root ◽  
Pathological Process ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Bleeding Complications ◽  
Sinotubular Junction ◽  
Computed Tomographic ◽  
Aortic Root Remodeling ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Objective In degenerative ascending aortic aneurysms (AAAs), the pathological process may extend into the aortic root, causing aortic regurgitation (AR). As often one or two sinuses are involved, ascending aorta replacement should be associated with selected sinus replacement. Methods Thirty patients (21 men and 9 women; mean ± SD age, 70.0 ± 10.4) were operated on for ascending aorta and selected sinus replacement. All patients had degenerative AAA with sinotubular junction and partial root dilatation: one or two sinuses of Valsalva were involved. Mild to moderate-severe AR was present in all patients. The mean ± SD logistic EUROscore 1 was 15.4 ± 12.5. Twenty patients had ascending aorta replacement associated with noncoronary sinus replacement; 8 patients, associated with both right and noncoronary sinuses; 1 patient, associated with both left and noncoronary sinuses; and 1 patient, associated with left coronary sinus alone. Results There were no hospital or late deaths. No thromboembolic event or bleeding complications were reported. Postoperative echocardiography did not show significant AR, and computed tomographic scanning revealed a normal positioning of the vascular graft in the ascending aorta. Conclusions Remodeling of the sinotubular junction with selected sinus replacement in degenerative AAA is a valuable approach for aortic root remodeling, leading to a significant reduction of AR when the aortic leaflets are normal.

scholarly journals Histological Regional Analysis of the Aortic Root and Thoracic Ascending Aorta: a Complete Analysis of Aneurysms From Root to Arch

2021 ◽  
Author(s):  
Timothy Luke Surman ◽  
John Matthew Abrahams ◽  
Jim Manavis ◽  
John Finnie ◽  
Dermot O’Rourke ◽  
...  
Keyword(s):  
Aortic Root ◽  
Regional Analysis ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Collagen I ◽  
Ultrastructural Changes ◽  
Complete Analysis ◽  
Elastin Fiber ◽  
Collagen Iii ◽  
Unique Composition

Abstract BackgroundAlthough aortic root and ascending aortic aneurysms are treated the same, they differ in embryological development and pathological processes. This study examines the microscopic structural differences between aortic root and ascending aortic aneurysms, correlating these features to the macroscopic pathophysiological processes. MethodsWe obtained surgical samples from ascending aortic aneurysms (n=11), aortic root aneurysms (n=3), and non-aneurysmal patients (n=7), Aortic collagen and elastin content were examined via histological analysis, and immunohistochemistry techniques used to determine collagen I, III, and IV subtypes. Analysis was via observational features, and colour deconvolution quantification techniques. ResultsElastin fiber disruption and fragmentation was the most extensive in the proximal aneurysmal regions. Medial fibrosis and collagen density increased in proximal aneurysmal regions and aortic root aneurysms (p<0.005). Collagen I was seen in highest quantity in aortic root aneurysms. Collagen I content was greatest in the sinus tissue regions compared to the valvular and ostial regions (p<0.005) Collagen III and IV quantification did not vary greatly. The most susceptible regions to ultrastructural changes in disease are the proximal ascending aorta and aortic root.ConclusionsThe aortic root differs histologically from the ascending aorta confirming its unique composition in aneurysm pathology. These findings should prompt further evaluation on the influence of this altered structure on function which could potentially guide clinical management.

scholarly journals Intra-Operative Rupture of Giant Ascending Aorta and Aortic Arch Aneurysm In Open Heart Surgery: A Successful Peri-operative Management

2021 ◽  
pp. 18
Author(s):  
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Operative Management ◽  
Aneurysm Rupture ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Open Heart ◽  
Coarctation Repair ◽  
Main Determinants ◽  
Arch Aneurysm

Introduction: Giant thoracic aortic aneurysms are rare. Most of the reported cases are not a known complication of aortic coarctation repair. Otherwise intra-operative aneurysm ruptures are rare cases but a potentially fatal complication in open heart surgery. Case report: In this article, we report the case of a 23-year-old patient with a giant ascending and arch aneurysm associated with a Standford type A chronic aortic dissection. In the patient’s history a coarctation repair at age of five years old was noted. During an open heart surgery for ascending aorta and hemi-arch replacement under cardiopulmonary bypass, aneurysm rupture occurred before aortic cross-clamp. A successful intraoperative and post-operative management was performed. The course was uneventful. The patient was extubated without neurological damage. Moreover, there were no kidney function deterioration, no digestive and limbs ischemia. Conclusion: Intra-operative aneurysm rupture is rare but is a major operative complication whose successful repair depends on an integrated intra-operative management. Cerebrovascular and heart protection are the main determinants of patient survival. Also, the surgical team’s prompt response is the key to the successful execution of the procedure.

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