scholarly journals Arterial hypertension and aortic root dilatation: an unsolved mystery

2013 ◽  
pp. 6-11
Author(s):  
Alberto Milan ◽  
Francesco Tosello ◽  
Sara Abram ◽  
Ambra Fabbri ◽  
Alessandro Vairo ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Aortic Wall ◽  
Aortic Aneurysms ◽  
Published Data ◽  
Thoracic Aortic Aneurysms ◽  
Biological Variables ◽  
Aortic Root Dilatation ◽  
Active Debate

Introduction: Acute and chronic aortic syndromes are associated with substantial morbidity and mortality. Silent risk factors such as arterial hypertension and aortic root dilatation can increase the likelihood of aortic dissection or rupture. The relationship between arterial hypertension and the dimensions of the aortic root dimension is a topic of active debate. Materials and methods: We reviewed the literature on the physiopathology, diagnosis, natural history, and management of thoracic aortic aneurysms. Results: Biological variables influencing the size of the aorta include age, sex, body surface area, pressure values, and stroke volume. Pathologic enlargement of the thoracic aorta can be caused by genetic, degenerative, inflammatory, traumatic, or toxic factors. Studies investigating the correlation between aortic dimensions and arterial pressures (diastolic, systolic, or pulse) have produced discordant results. Discussion: Classically, emphasis has been placed on the importance of hypertension-related degeneration of the medial layer of the aortic wall, which leads to dilatation of the thoracic aorta, reduced aortic wall compliance, and increased pulse pressures. However, there are no published data that demonstrate unequivocally the existence of a pathogenetic correlation between arterial hypertension and aortic root dilatation. Furthermore, there is no evidence that antihypertensive therapy is effective in the management of nonsyndromic forms of aortic root dilatation. An interesting branch of research focuses on the importance of genetic predisposition in the pathogenesis of thoracic aortic aneurysms. Different genetic backgrounds could explain differences in the behaviour of aortic walls exposed to the same hemodynamic stress. Further study is needed to evaluate these focal physiopathological aspects.

Endovascular versus open treatment of degenerative aneurysms of the descending thoracic aorta: a single center experience

Vascular ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Joachim Andrassy ◽  
Rolf Weidenhagen ◽  
Georgios Meimarakis ◽  
M Rentsch ◽  
K-W Jauch ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Open Surgery ◽  
Aortic Aneurysms ◽  
Descending Thoracic Aorta ◽  
Entire Cohort ◽  
Thoracic Aortic Aneurysms ◽  
Asymptomatic Patients ◽  
Open Treatment ◽  
One Year

Multiple reports could show a reduced risk for thoracic endovascular aortic repair (TEVAR) compared with open treatment. The aim of this study was to evaluate our twelve-year TEVAR experience for thoracic aortic aneurysms and compare these results with open repair. All patients who had received either open or endovascular surgery for a degenerative aortic aneurysm of the descending thoracic aorta in our center were evaluated retrospectively. N = 53 TEVAR patients (1997–2008) were included and their course was compared with an open-surgery group of n = 24 patients (1992–2002). The percentage of symptomatic patients was 43% (TEVAR) and 42% (open surgery). Endovascular treatment resulted in a significantly reduced 30-day (5.7% versus 25% P = 0.02) and one-year mortality (19% versus 42% P = 0.05) in the entire cohort. Symptomatic patients benefited the most from TEVAR (30-day mortality: 9% versus 40%, P = 0.06; one-year mortality: 27% versus 70%, P = 0.049) whereas the survival of our asymptomatic patients was not significantly different (30-day mortality: 3% versus 14%, P = 0.22; one-year mortality: 13% versus 21%, P = 0.65). Lastly, Kaplan–Meier analysis showed a significantly improved survival after TEVAR ( P = 0.05) and in particular for the symptomatic patients ( P = 0.003). In conclusion, endovascular treatment for patients with degenerative thoracic aortic aneurysms has significant advantages over open surgery.

Ascending Thoracic Aorta Exhibits Anisotropic Failure Behavior in Shear Lap Testing

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.

P6497Loeys-Dietz syndrome-5: phenotypic spectrum of TGFB3 mutations in an international cohort and first report of a homozygous patient

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Marsili ◽  
E Overwater ◽  
N Hanna ◽  
G Baujat ◽  
M J H Baars ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Aortic Root ◽  
Aortic Surgery ◽  
Artery Aneurysm ◽  
Index Patient ◽  
Connective Tissue Disorder ◽  
Aortic Aneurysms ◽  
Aortic Dilatation ◽  
Iliac Artery Aneurysm ◽  
Aortic Root Dilatation

Abstract Background Mutations in TGFB3 cause Loeys-Dietz syndrome-5 (LDS5), an autosomal dominantly inherited connective tissue disorder. LDS5 is characterized by aortic aneurysms and dissections associated with systemic features mainly involving the ocular and skeletal systems. Precise delineation of LDS5 phenotype is difficult because of the small number of identified cases. Purpose The purpose of this study was to further define LDS5 with an emphasis on cardiologic features by describing the genotype and phenotype in an international cohort of patients. Methods We performed a retrospective cross-sectional multicentre study. Genetic testing was performed as a part of standard medical care. Clinical data were collected by means of an anonymized questionnaire, which was sent to the referent physicians. Results Ten (7 novel) TGFB3 mutations were identified in 31 patients (16 index patients). The mean age at last evaluation was 32 years (range 4–60 years). Aortic root dilatation, varices, and mitral valve insufficiency were the most common cardiovascular findings, reported in 28%, 22%, and 21% of patients, respectively. Higher incidences (40%, 29%, and 25%) of these findings were observed in the index patients. Four patients (8%) underwent aortic surgery, all after age 40. Abdominal aortic aneurysms were reported in 2/26 (8%) patients. Extra aortic artery disease included iliac artery aneurysm (one index patient) and tortuosity of the internal carotid and vertebral arteries (one index patient and one relative). The most frequently reported systemic features were high-arched palate, arachnodactyly, pes planus, pectus deformity, and joint hypermobility. Interestingly, we identified an homozygous TGFB3 mutation in a patient who presented with aortic dilatation at age 17, splenic torsion, severe myopia, cleft palate, and other skeletal features. Her heterozygous parents, brother, and sister displayed signs of the disease, but to a milder degree. To the best of our knowledge, this is the first identification of homozygous TGFB3 mutation. Conclusions Our data are in line with previous research, showing that aortic root dilatation is the main cardiovascular feature of LDS5. No deaths related to cardiovascular events were reported in any of the presented families. The cardiovascular phenotype of LDS5 appears to be milder compared to other vascular connective tissue disorder, such as Marfan syndrome, although our findings suggest that homozygosity is associated with a more severe and early-onset phenotype.

Robotic Replacement of the Descending Thoracic Aorta: An Alternative to Endovascular Therapy?

2006 ◽  
Vol 1 (3) ◽  
pp. 115-118
Author(s):  
Eyal E. Porat ◽  
Peter D. Herrera ◽  
Roy Sheinbaum ◽  
Anthony L. Estrera ◽  
Tam T.T. Huynh ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Lung Ventilation ◽  
Aortic Aneurysms ◽  
Added Value ◽  
Long Term Results ◽  
Dacron Graft ◽  
Descending Thoracic Aorta ◽  
Thoracic Aortic Aneurysms

Background Replacement of the descending thoracic aorta is traditionally performed via a left thoracotomy. Endovascular treatment of descending thoracic aortic aneurysms has recently evolved as an alternative treatment for selected patients, yet no long-term results are available. The authors replaced the descending thoracic aorta in a group of pigs with an interposition Dacron graft using a closed-chest, totally robotic technique. Methods Ten pigs, weighing 25 to 45 kg, underwent surgery using the DaVinci robotic surgical system. Under single-lung ventilation and CO2 insufflation, the descending thoracic aorta was completely mobilized. Proximal and distal cross-clamps were applied through separate accessory stab wounds. The mid-descending thoracic aorta was excised. An interposition Dacron graft was robotically sewn in an end-to-end fashion to the descending thoracic aorta using interrupted nitinol clips. Results All animals survived the procedure. Mean aortic clamp time was 55 ± 14 minutes. All anastomoses were completed without difficulty with a mean total anastomotic time of 42 ± 11 minutes. The anastomoses were challenged for bleeding by administrating α1-adrenergic receptor agonists to a systolic blood pressure of 200 mm Hg with no evidence of leak. Discussion Robotic replacement of the thoracic aorta is feasible and reproducible. This procedure provides the standard Dacron graft repair with its known long-term results. The added value of robotic technology to the therapeutic armamentarium in the treatment of thoracic aortic aneurysms may be worth the effort required for procedural development. Furthermore, it may serve as a valid alternative to endovascular treatment of thoracic aortic aneurysms.

scholarly journals Significance of Hemodynamics Biomarkers, Tissue Biomechanics and Numerical Simulations in the Pathogenesis of Ascending Thoracic Aortic Aneurysms

2020 ◽  
Vol 26 ◽  
Author(s):  
Salvatore Campisi ◽  
Raja Jayendiran ◽  
Francesca Condemi ◽  
Magalie Viallon ◽  
Pierre Croisille ◽  
...  
Keyword(s):  
Aortic Wall ◽  
Aortic Rupture ◽  
Scientific Evidence ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Imaging Biomarkers ◽  
Aortic Tissue ◽  
Thoracic Aortic Aneurysms ◽  
Non Invasive ◽  
Valve Function

Abstract:: Guidelines for the treatment of aortic wall diseases are based on measurements of maximum aortic diameter. However aortic rupture or dissections do occur for small aortic diameters. Growing scientific evidence underlines the importance of biomechanics and hemodynamics in aortic disease development and progression. Wall shear stress (WWS) is an important hemodynamics marker which depends on aortic wall morphology and on the aortic valve function. WSS could be helpful to interpret aortic wall remodeling and define personalized risk criteria. The complementarity of Computational Fluid Dynamics and 4D Magnetic Resonance Imaging as tools for WSS assessment is a promising reality. The potentiality of these innovative technologies will provide maps or atlases of hemodynamics biomarkers to predict aortic tissue dysfunction. Ongoing efforts should focus on the correlation between these non-invasive imaging biomarkers and clinico-pathologic situations for the implementation of personalized medicine in current clinical practice.

scholarly journals Phenotypic and Functional Changes of Endothelial and Smooth Muscle Cells in Thoracic Aortic Aneurysms

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Anna Malashicheva ◽  
Daria Kostina ◽  
Aleksandra Kostina ◽  
Olga Irtyuga ◽  
Irina Voronkina ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Smooth Muscle ◽  
Aortic Valve ◽  
Smooth Muscle Cells ◽  
Aortic Wall ◽  
Muscle Cells ◽  
Aortic Aneurysms ◽  
Cell Phenotype ◽  
Functional Markers ◽  
Thoracic Aortic Aneurysms

Thoracic aortic aneurysm develops as a result of complex series of events that alter the cellular structure and the composition of the extracellular matrix of the aortic wall. The purpose of the present work was to study the cellular functions of endothelial and smooth muscle cells from the patients with aneurysms of the thoracic aorta. We studied endothelial and smooth muscle cells from aneurysms in patients with bicuspid aortic valve and with tricuspid aortic valve. The expression of key markers of endothelial (CD31, vWF, and VE-cadherin) and smooth muscle (SMA, SM22α, calponin, and vimentin) cells as well extracellular matrix and MMP activity was studied as well as and apoptosis and cell proliferation. Expression of functional markers of endothelial and smooth muscle cells was reduced in patient cells. Cellular proliferation, migration, and synthesis of extracellular matrix proteins are attenuated in the cells of the patients. We show for the first time that aortic endothelial cell phenotype is changed in the thoracic aortic aneurysms compared to normal aortic wall. In conclusion both endothelial and smooth muscle cells from aneurysms of the ascending aorta have downregulated specific cellular markers and altered functional properties, such as growth rate, apoptosis induction, and extracellular matrix synthesis.

scholarly journals “ELEPHANT TRUNK” AND ENDOVASCULAR STENTGRAFTING – A HYBRID APPROACH TO THE TREATMENT OF EXTENSIVE THORACIC AORTIC ANEURYSM

2013 ◽  
Vol 56 (2) ◽  
pp. 80-82 ◽  
Author(s):  
Tomáš Holubec ◽  
Jan Raupach ◽  
Jan Dominik ◽  
Jan Vojáček
Keyword(s):  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Hybrid Approach ◽  
Giant Aneurysm ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Mortality And Morbidity ◽  
Thoracic Aortic Aneurysms ◽  
Ventricular Septum Defect ◽  
Elephant Trunk Technique

A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant aortic and tricuspid regurgitation and ventricular septum defect. The patient underwent multiple consecutive operations and interventions having, among others, finally replaced the entire thoracic aorta with the use of the hybrid elephant trunk technique.

scholarly journals Thoracic aorta aneurysm- a rare cause of chronic backache with mediastinal shadow: case report

2018 ◽  
Vol 4 (12) ◽  
pp. 296
Author(s):  
Akash Mathur ◽  
Devleena Gangopadhyay ◽  
Ashutosh Daga ◽  
Puneet Saxena ◽  
Hemant Malhotra
Keyword(s):  
Case Report ◽  
Thoracic Aorta ◽  
Beta Blockers ◽  
Left Lung ◽  
Lower Lobe ◽  
Symptomatic Treatment ◽  
Aortic Aneurysms ◽  
Aorta Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Thoracic Aorta Aneurysm

<p class="abstract">Thoracic aortic aneurysms (TAA) are rarely symptomatic. A 55 year old male presents with longstanding chronic backache. CXR showed left hilar shadow with collapse of left lung. Considering the CXR findings and with the patient being chronic smoker a strong possibility of carcinoma lung with bony metastasis was kept and further CECT chest was done. The CECT chest was suggestive of a thoracic aorta aneurysm with thrombosis compressing left principal bronchus and its lower lobar branch resulting in distal area of collapse and consolidation of left lower lobe. These findings were further confirmed on CT angiography. The patient was thus diagnosed as a case of descending thoracic aorta aneurysm probably of atherosclerotic etiology with thrombosis. Patient was started on beta blockers and ACE inhibitors along with supportive and symptomatic treatment and was further transferred to the department of CTVS for surgical intervention. Thus, this case report here signifies that possibility of thoracic aorta aneurysm should always be considered in a patient with chronic backache specially in presence of mediastinal shadow on CXR.</p>

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