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 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 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 The change of collagen in rabbit conjunctiva after conjunctiva cross-linking

2019 ◽  
Author(s):  
Lijuan Mo ◽  
Hanmin Wang ◽  
Li Huang ◽  
Yanxiang Gui ◽  
Qingsong Li
Keyword(s):  
Treatment Group ◽  
Statistical Significance ◽  
Average Density ◽  
Collagen Fibrils ◽  
Collagen I ◽  
Ultrastructural Changes ◽  
Cross Linking ◽  
Control Group ◽  
Collagen Iii ◽  
Uva Light

Abstract Background We aimed to determine the ultrastructural changes of collagen fibrils in the rabbit conjunctiva after conjunctiva cross-linking using riboflavin and UVA light of 45mW / cm 2 irradiation intensity. Conjunctiva cross-linking may increase conjunctiva stiffness. Methods The super-temporal quadrant of the right eyes of twenty-four adult rabbits were treated with topical riboflavin solution (0.25%) followed by irradiation with UVA light (45mW/cm 2 ) for 4 min. After 3 weeks, the collagen fibrils in fibril bundles were examined with electron microscopy. Immunohistochemical staining was applied to detect the expression of collagen I and III in the rabbits’ conjunctiva. Results The diameter of collagen fibrils in the fibril bundles varied slightly and ranged from 30 to 60 nm in control group conjunctival stroma. While in the treatment group, the diameter of collagen fibrils ranged from 60 to 90 nm. Thickest collagen fibrils were observed in the treatment group (fibril diameters up to 90 nm), whereas thickest collagen fibrils in control group conjunctival stroma are considerable smaller (up to 60 nm in diameter). However, both of the thickness of collagen fibrils displayed a unimodal distribution. Collagen I and collagen III were increased after treatment with riboflavin and UVA light of 45 mW/cm 2 .Conclusions The data indicate that in rabbits, conjunctiva cross-linking with riboflavin and UVA light of 45 mW/cm 2 for 4 min is relatively safe and does not induce ultrastructural alterations of conjunctiva cells. The conjunctiva cross-linking riboflavin and UVA light of 45 mW/cm 2 can increase the diameter of collagen fibrils, but the average density of collagen I and collagen III have no statistical significance.

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 Inhibition of Angiotensin II Dependent AT1a Receptor Stimulation Attenuates Thoracic Aortic Pathology in Fibrillin-1C1041G/+ Mice

2020 ◽  
Author(s):  
Jeff Z. Chen ◽  
Hisashi Sawada ◽  
Jessica J. Moorleghen ◽  
Michael K. Franklin ◽  
Deborah A. Howatt ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Aortic Root ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
List Type ◽  
Angiotensin Receptor ◽  
Aortic Pathology ◽  
Medial Thickening ◽  
Stimulation Of

AbstractGraphic AbstractObjectiveA cardinal feature of Marfan syndrome is thoracic aortic aneurysm (TAA). The contribution of ligand-dependent stimulation of angiotensin II receptor type 1a (AT1aR) to TAA progression remains controversial because the beneficial effects of angiotensin receptor blockers have been ascribed to off-target effects. This study used genetic and pharmacologic modes of attenuating angiotensin receptor and ligand, respectively, to determine their roles on TAA in mice with fibrillin-1 haploinsufficiency (Fbn1C1041G/+).Approach and ResultsTAA in Fbn1C1041G/+ mice were determined in both sexes and found to be strikingly sexual dimorphic. Males displayed progressive dilation over 12 months while ascending aortic dilation in Fbn1C1041G/+ females did not differ significantly from wild type mice. To determine the role of AT1aR, Fbn1C1041G/+ mice that were either +/+ or −/− for AT1aR were generated. AT1aR deletion reduced progressive expansion of ascending aorta and aortic root diameter from 1 to 12 months of age in males. Medial thickening and elastin fragmentation were attenuated. An antisense oligonucleotide against angiotensinogen (AGT-ASO) was administered to male Fbn1C1041G/+ mice to determine the effects of angiotensin II depletion. AGT-ASO administration, at doses that markedly reduced plasma AGT concentrations, attenuated progressive dilation of the ascending aorta and aortic root. AGT-ASO also reduced medial thickening and elastin fragmentation.ConclusionsGenetic approaches to delete AT1aR and deplete AngII production exerted similar effects in attenuating pathology in the proximal thoracic aorta of male Fbn1C1041G/+ mice. These data are consistent with ligand (AngII) dependent stimulation of AT1aR being responsible for aortic disease progression.HighlightsProfound sexual dimorphism of aortic disease occurs in Fbn1C1041G/+ mice, with female mice being more resistant and male mice being more susceptible.Inhibition of the AngII-AT1aR axis attenuates aortic pathology in male Fbn1C1041G/+ mice.Antisense oligonucleotides targeting angiotensinogen deplete plasma angiotensinogen and attenuate thoracic aortic aneurysms.

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.

Isolated aortic dilation without osteoarthritis: a case of SMAD3 mutation

2018 ◽  
Vol 28 (5) ◽  
pp. 765-767 ◽  
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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