Abstract
The aorta is not a rigid tube, it is an “organ” with lamellar units, consisting of elastic fibers, extracellular matrix and smooth muscle cells in between as parenchyma. Several diseases may occur in the natural history of the aorta, requiring replacement of both semilunar cusps and ascending aorta. They may be congenital defects, such as bicuspid aortic valve and isthmal coarctation with aortopathy; genetically determined, such as Marfan and William syndromes; degenerative diseases, such as atherosclerosis and medial necrosis with aortic dilatation, valve incompetence and dissecting aneurysm; inflammatory diseases such as Takayasu arteritis, syphilis, giant cell and IgM4 aortitis; neoplasms; and trauma. Aortic homografts from cadavers, including both the sinus portion with semilunar cusps and the tubular portion, are surgically employed to replace a native sick ascending aorta. However, the antigenicity of allograft cells, in the lamellar units and interstitial cells in the cusps, is maintained. Thus, an immune reaction may occur, limiting durability. After proper decellularization and 6 months’ implantation in sheep, endogenous cell repopulation was shown to occur in both the valve and aortic wall, including the endothelium, without evidence of inflammation and structural deterioration/calcification in the mid-term. The allograft was transformed into an autograft.
Highlights
Along with natural history, the aorta, the highway of our body, transforms from a Academic Editor: Robert Poelmann smooth, pliable vessel in children into a rigid tube in the elderly (Figure 1) [1,2]
The aorta is a smooth great vessel consisting of intima, media and adventitia
Natural history of Bicuspid aortic valve (BAV) is characterized by progressive calcification of the cusps with aortic valve stenosis [10] and by aortopathy (Figure 5) with dilatation of the ascending aorta, valve incompetence and aortic dissection (Figure 6) [11,12,13]
Summary
The aorta, the highway of our body, transforms from a Academic Editor: Robert Poelmann smooth, pliable vessel in children into a rigid tube in the elderly (Figure 1) [1,2]. If normal or nearly normal, it may be donated at the time of death to serve as an arterial allograft for. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. 1. (a) Normal thoracic aorta in a child; (b) Severe atherosclerosis of the aorta in an old man
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