Left main stenting induced flow disturbances on ascending aorta and aortic arch

Abstract Background and Objective Ostial LM stenting potentially induces turbulence in the aortic wall near the LM ostium, which might be correlated with aorta dilation and dissection. We investigated through a computational fluid dynamic analysis (CFD), the presence and potential consequences of flow turbulences both in the ascending aorta and arch after a stenting left main (LM) mid shaft or distal disease. Methods The model of the ascending aorta and left coronary artery was reconstructed reviewing both angiographic and echocardiographic measurements of 80 consecutive patients (43 males, mean age 75.1 ± 6.2 years) with significant LM mid shaft or distal disease treated in our institution. For stent simulation, a third-generation everolimus-eluting stent was reconstructed. Two stenting procedures (lesion 1:1 or ostial coverage) were investigated. Results The net area averaged WSS of the model resulted higher when the stent covered the lesion 1:1 compared to the ostial coverage (3.68 vs. 2.06 Pa, P=0.01 and 3.97 vs. 1.98 Pa, P < 0.001, respectively). LM ostial coverage generates more turbulences in the LM itself, in the aortic wall at ostium level, and at the sino-tubular junction compared with the stenting of the lesion 1:1. Conversely, in the ascending aorta, the WSS appears lower when stenting the lesion 1:1. Conclusion Extending the stent coverage up to the ostium, when the ostial region is not diseased, might induce unfavorable alterations of flow; not only both at the level of the LM lesion and ostium sites, but also in the ascending aorta and aortic arch, potentially predisposing the aortic wall to long-term damage.

Download Full-text

Multiphoton Microscopy of Healthy and Aneurismal Human Ascending Aorta

ASME 2009 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2009-206152 ◽

2009 ◽

Author(s):

Stacey L. Meadley ◽

Umakanta Tripathy ◽

Paul W. Wiseman ◽

Richard L. Leask

Keyword(s):

Blood Flow ◽

Aortic Wall ◽

Surgical Intervention ◽

Multiphoton Microscopy ◽

Ascending Aorta ◽

The Body ◽

Physiological Conditions ◽

Flow Disturbances ◽

Original Size ◽

Elastic Lamina

The ascending aorta (AA) is the largest artery in the human body. It is responsible for transporting blood between the heart and the rest of the body. The structure of the AA allows it to withstand the resulting blood flow forces. This unique structure is due primarily to the proteins collagen and elastin. Collagen accounts for the strength of the aorta while the mechanical properties of the tissue, under healthy physiological conditions, is dominated by the elastin. Aneurysms are the primary disease associated with the AA, where the diameter of the vessel increases over 1.5 times its original size. Aneurysms can result in severe blood flow disturbances or rupture of the AA and almost always require surgical intervention. The development of an aneurysm is due to a weakening of the aortic wall, specifically the degradation of the structural proteins. This study examines the changes that occur to collagen and elastin in the ascending aorta with aneurysms using multiphoton microscopy. Specifically, the orientation of collagen fibers and the morphology of the fenestrations in the elastic lamina are compared between healthy and dilated human ascending aortas.

Download Full-text

Comparison of pulse-wave velocity in different aortic regions in relation to the extent and severity of atherosclerosis between young and older Kurosawa and Kusanagi-Hypercholesterolemic (KHC) rabbits

Clinical Science ◽

10.1042/cs0990393 ◽

2000 ◽

Vol 99 (5) ◽

pp. 393-404 ◽

Cited By ~ 9

Author(s):

Shin-ichiro KATSUDA ◽

Masamitsu HASEGAWA ◽

Masahiko KUSANAGI ◽

Tsuyoshi SHIMIZU

Keyword(s):

Elastic Modulus ◽

Pulse Wave Velocity ◽

Aortic Arch ◽

Thoracic Aorta ◽

Wave Velocity ◽

Abdominal Aorta ◽

Aortic Wall ◽

Pulse Wave ◽

Age Groups ◽

Ascending Aorta

The present study was performed to investigate the effects of the development of atherosclerosis on foot-to-foot pulse-wave velocity (PWV) from the ascending aorta to different positions along the aorta in Kurosawa and Kusanagi-Hypercholesterolemic (KHC) rabbits aged 10–12 and 22–24 months old, in relation to the percentage fractional lesioned area (PFLA) in different aortic regions through which the pulse wave travels, as well as the rheological and pathohistological properties of the aortic wall. PWV, when measured in the KHC rabbit from the ascending aorta to each aortic position, showed the highest value on passage through the aortic arch, decreased with conduction to the distal thoracic aorta, reached the minimal value on passage to the distal thoracic aorta or to the middle abdominal aorta in the 10–12- and 22–24-month-old animals respectively, and increased gradually on conduction to the iliac artery. PWV at all aortic regions examined was significantly greater in the 22–24-month-old than in the 10–12-month-old KHC rabbits. PFLA, when measured in the aortic region from the ascending aorta to each aortic position, was maximal in the aortic arch and decreased gradually towards the peripheral aorta in both age groups. PFLA in the 22–24-month-old group was significantly greater than that in the 10–12-month-old group in all aortic regions examined. The atherosclerotic aortic wall showed a significantly lower elastic modulus in the young KHC rabbits compared with age-matched normal rabbits. A significantly higher elastic modulus was observed in the older KHC rabbits compared with that in the younger animals of both strains, associated with the progression of sclerosis. These findings indicate that the increase in PWV is due mainly to an increase with aging in the extent and severity of atherosclerosis in vessels in which the pulse wave travels.

Download Full-text

Pseudoaneurysm as a Late Complication of Hybrid Aortic Arch Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000308 ◽

2016 ◽

Vol 11 (5) ◽

pp. 360-362 ◽

Cited By ~ 1

Author(s):

Cristian Rosu ◽

Nicolas Beaulieu ◽

Raymond Cartier ◽

Philippe Demers

Keyword(s):

Aortic Arch ◽

Aortic Wall ◽

Late Complication ◽

Ascending Aorta ◽

Proximal Anastomosis ◽

Stent Grafting ◽

Landing Zone ◽

Initial Procedure ◽

Aortic Arch Repair ◽

Arch Aneurysm

Hybrid aortic arch repair is increasingly used for the management of aortic arch aneurysm. Pseudoaneurysm is a newly described late complication of this procedure. A 57-year-old man underwent emergent supra-aortic debranching and aortic arch stent grafting after rupture of an arch aneurysm. Three years later, the patient presented with a pseudoaneurysm at the junction between the stent graft's proximal landing zone and the origin of the debranching graft. At reoperative repair, the proximal stent graft had eroded through the aortic wall at the junction of the endograft proximal landing zone and the proximal anastomosis of the debranching graft. The presence of a dilated, fragile ascending aorta at the initial procedure seemed to be a risk factor for development of the pseudoaneurysm. Replacement of the ascending aorta combined with supra-aortic debranching has become an accepted strategy in hybrid arch repair to establish a suitable landing zone for the endograft.

Download Full-text

Relation of sympathetic activation and stress-induced hypertension in atherosclerosis of the thoracic aorta: a cadaveric study

International Surgery Journal ◽

10.18203/2349-2902.isj20205343 ◽

2020 ◽

Vol 7 (12) ◽

pp. 3913

Author(s):

Apostolos S. Gogakos ◽

Triantafyllia D. Koletsa ◽

Leonidas C. Pavlidis ◽

Dimitrios A. Paliouras ◽

Thomas S. Rallis ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Wall ◽

Age Groups ◽

Ascending Aorta ◽

Variable Degree ◽

Strong Negative Correlation ◽

Descending Aorta ◽

Induced Hypertension ◽

Neuron Terminals

Background: The autonomic nervous system (ANS) has been associated with numerous atherosclerosis-induced cardiovascular events, such as myocardial infarction and aortic disease. Although evidence suggests a relationship between autonomic dysfunction and atherosclerotic disease, the underlying mechanisms are still under investigation. The purpose of this study is to investigate the effect of ANS to the development of atherosclerosis and vice versa, in human thoracic aorta.Methods: An autopsy analysis from three segments of the thoracic aorta was performed; ascending aorta, aortic arch, descending aorta, using 52 unselected adult cadavers (38 male, 14 female – mean age 64.4 years; age range 19-90 years). Subjects were divided in two age groups (<65 years – N=26, >65 years – N=26). Tissue specimens were macroscopically examined and histopathologically divided into 7 grades of scoring for atherosclerosis (ATHERO, from 0=intact, to 6=thrombi formation). The relationship between ANS and atherosclerosis was depicted by further immunohistochemical analysis for detection of neuron terminals onto the aortic wall. All data were evaluated according to the subjects’ demographic and clinical characteristics.Results: Total 96.2% of all subjects had atherosclerosis of variable degree in one or more segments. No aneurismal change was found. The presence of atheromas were common in all subjects regardless of age and segment, with atherosclerosis increasing by age; ascending aorta (r=0.571, p<0.001), aortic arch (r=0.655, p<0.001), descending aorta (r=0.659, p<0.001). Hypertension was a significant factor in the development of atherosclerosis in adults >65 years (r=0.450, p=0.023). In addition, a positive history of hypertension was statistically significant regarding both the presence of atherosclerosis and neuron terminals in all three aortic wall segments; ascending aorta (p=0.037), Aaortic arch (p=0.046), descending aorta (p=0.045). Furthermore, there was a strong negative correlation between the ATHERO score and the presence of neuron terminals in all three aortic segments; ascending aorta (r=-0.264, p=0.041), aortic arch (r=-0.400, p=0.003), descending aorta (r=-0.234, p=0.047).Conclusions: Human cadaveric studies are extremely useful in understanding the pathophysiology of ANS, along with clinical and animal studies that are most commonly performed. These data suggest that there is a link between autonomic disfunction and the presence of atherosclerosis in human thoracic aorta, especially when hypertension is present. It is therefore possible that stress-induced hypertension can be considered as a potential risk factor for the development of atherosclerosis.

Download Full-text

Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

Download Full-text

Surgery of the ascending aorta and the aortic arch through partial upper sternotomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246770 ◽

2010 ◽

Vol 58 (S 01) ◽

Author(s):

H Deschka ◽

M Machner ◽

S El Dsoki ◽

A Alken ◽

G Wimmer-Greinecker

Keyword(s):

Aortic Arch ◽

Ascending Aorta

Download Full-text

Aneurysm Hybrid Treatment by Simultaneous Replacement of Ascending Aorta and Aortic Arch and Endoluminal Stenting of the Descending Aorta

The Heart Surgery Forum ◽

10.1532/hsf98.20051033 ◽

2006 ◽

Vol 9 (1) ◽

pp. E530-E532

Author(s):

Friedrich-Christian Riess ◽

Hans Krankenberg ◽

Thilo Tübler ◽

Matthias Danne

Keyword(s):

Aortic Arch ◽

Ascending Aorta ◽

Descending Aorta ◽

Hybrid Treatment

Download Full-text

Anterior Mediastinal Paraganglioma Mimicking Thymoma

The Heart Surgery Forum ◽

10.1532/hsf98.20111173 ◽

2012 ◽

Vol 15 (3) ◽

pp. 170

Author(s):

Hee Moon Lee ◽

Dong Seop Jeong ◽

Pyo Won Park ◽

Wook Sung Kim ◽

Kiick Sung ◽

...

Keyword(s):

Mediastinal Mass ◽

Aortic Wall ◽

Anterior Wall ◽

Ascending Aorta ◽

Anterior Mediastinal Mass ◽

Arterial Reconstruction ◽

Ct Evaluation ◽

One Year ◽

Mediastinal Paraganglioma

A 54-year-old man was referred to our institution with hemoptysis and hoarseness of 1 year's duration. A computed tomography (CT) scan showed an anterior mediastinal mass (2.5 cm x 1.0 cm), which was diagnosed as thymoma. The tumor was resected under a sternotomy. The tumor had invaded the anterior wall of the ascending aorta. With the patient under cardiopulmonary bypass, the aortic wall invaded by the mass was resected, and arterial reconstruction was performed with patch material. The tumor was revealed to be a tumor of neuronal origin. The patient's postoperative course was uneventful. The patient was discharged on postoperative day 9. One year after the operation, a follow-up chest CT evaluation showed no specific complications or recurrence.

Download Full-text