How does the ascending aorta geometry change when it dissects?

Autor:	Rylski B; Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany. Electronic address: bartosz.rylski@universitaets-herzzentrum.de., Blanke P; Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany., Beyersdorf F; Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany., Desai ND; Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Milewski RK; Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania., Siepe M; Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany., Kari FA; Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany., Czerny M; Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland., Carrel T; Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland., Schlensak C; Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany., Krüger T; Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany., Mack MJ; Division of Cardiothoracic Surgery, Baylor Healthcare System, The Heart Hospital, Plano, Texas., Brinkman WT; Division of Cardiothoracic Surgery, Baylor Healthcare System, The Heart Hospital, Plano, Texas., Mohr FW; Department of Cardiac Surgery, Leipzig Heart Center-University of Leipzig, Leipzig, Germany., Etz CD; Department of Cardiac Surgery, Leipzig Heart Center-University of Leipzig, Leipzig, Germany., Luehr M; Department of Cardiac Surgery, Leipzig Heart Center-University of Leipzig, Leipzig, Germany., Bavaria JE; Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2014 Apr 08; Vol. 63 (13), pp. 1311-1319. Date of Electronic Publication: 2014 Feb 05.
DOI:	10.1016/j.jacc.2013.12.028
Abstrakt:	Objectives: The purpose of this study is to delineate changes in aortic geometry and diameter due to dissection. Background: Aortic diameter is the major criterion for elective ascending aortic replacement for dilated ascending aortas to prevent aortic dissection. However, recommendations are made on the basis of clinical experience and observation of diameters of previously dissected aortas. Methods: Six tertiary centers on 2 continents reviewed their acute aortic dissection type A databases, which contained 1,821 patients. Included were all non-Marfan patients with nonbicuspid aortic valves who had undergone computed tomography angiography <2 years before and within 12 h after aortic dissection onset. Aortic geometry before and after dissection onset were compared. Results: Altogether, 63 patients were included (27 spontaneous and 36 retrograde dissections, median age 68 [57; 77] years; 54% were men). In all but 1 patient, maximum ascending aortic diameter was <55 mm before aortic dissection onset. The largest increase in diameter and volume induced by the dissection were observed in the ascending aorta (40.1 [36.6; 45.3] mm vs. 52.9 [46.1; 58.6] mm, +12.8 mm; p < 0.001; 124.0 [90.8; 162.5] cm(3) vs. 171.0 [147.0; 197.0] cm(3), +47 cm(3); p < 0.001). Mean aortic arch diameter increased from 39.8 (30.5; 42.6) mm to 46.4 (42.0; 51.6) mm (+6.6 mm; p < 0.001) and descending thoracic aorta diameter from 31.2 (27.0; 33.3) mm to 34.9 (30.9; 39.5) mm (+3.7 mm; p < 0.001). Changes in thoracic aorta geometry were similar for spontaneous and retrograde etiology. Conclusions: Geometry of the thoracic aorta is affected by aortic dissection, leading to an increase in diameter that is most pronounced in the ascending aorta. Both spontaneous and retrograde dissection result in similar aortic geometry changes. (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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