Acute Aortic Pathology Research Articles

Correlation Between Intraoperative Near-infrared Spectroscopy Values and Neurologic Outcomes in Patients Undergoing Total Aortic Arch Replacement Using the Frozen Elephant Trunk Technique

ObjectiveTo correlate intraoperative near-infrared-spectroscopy (NIRS) values to neurologic outcome in patients undergoing total aortic arch replacement using the frozen elephant trunk (FET) technique. DesignRetrospective, single centre registry study using a two-way repeated measures ANOVA. SettingBetween 11/2013 and 12/2023, 427 patients were treated for acute and chronic aortic pathologies using FET procedure. ParticipantsOne-hundred sixty-six patients who had complete NIRS data at all predefined timepoints were included and retrospectively divided into two groups: patients with stroke diagnosed by experienced radiologists and clinicians and patients without stroke after FET. MeasurementsBilateral NIRS values were recorded continuously and at seven critical timepoints in each patient a correlation was made between left- and right-sided NIRS values and stroke. Main Results23 patients (13.9%) were diagnosed with a stroke. There was a significantly higher in-hospital mortality in patients with stroke (21.7%) compared to patients without stroke (7.7%) (p = 0.037). Left sided regional cerebral oxygenation (rSO2) did not show any significant difference in patients with stroke versus patients without stroke (p = 0.550). There were differences detected in right sided rSO2 trends (p < 0.001) and the inter-hemisphere NIRS at the specified timepoints (p = 0.009). The interaction Time x Stroke, however, did not show any significant results in all our analyses (p > 0.05). ConclusionNIRS is a reliable tool to monitor intraoperative frontal lobe cerebral oxygen saturation. However, its use to predict postoperative stroke remains limited. Further refinements are needed to develop the technique to a prediction tool.

E-vita OPEN NEO in the treatment of acute or chronic aortic pathologies: first interim results of the NEOS study.

The aim of this multicentre study was to demonstrate the safety and clinical performance of E-vita OPEN NEO Stent Graft System (Artivion, Inc.) in the treatment of aneurysm or dissection, both acute and chronic, in the ascending aorta, aortic arch and descending thoracic aorta. In this observational study of 12 centres performed in Europe and in Asia patients were enrolled between December 2020 and March 2022. All patients underwent frozen elephant trunk using E-vita OPEN NEO Stent Graft System. Primary end point was the rate of all-cause mortality at 30 days and secondary end points included further clinical and safety data are reported up to 3-6 months postoperatively. A total of 100 patients (66.7% male; mean age, 57.7 years) were enrolled at 12 sites. A total of 99 patients underwent surgery using the E-vita OPEN NEO for acute or subacute type A aortic dissection (n = 37), chronic type A aortic dissection (n = 33) or thoracic aortic aneurysm (n = 29), while 1 patient did not undergo surgery. Device technical success at 24 h was achieved in 97.0%. At discharge, new disabling stroke occurred in 4.4%, while new paraplegia and new paraparesis was reported in 2.2% and 2.2%, respectively. Renal failure requiring permanent (>90 days) dialysis or hemofiltration at discharge was observed in 3.3% of patients. Between discharge and the 3-6 months visit, no patients experienced new disabling stroke, new paraplegia or new paraparesis. The 30-day mortality was 5.1% and the estimated 6-month survival rate was 91.6% (standard deviation: 2.9). Total arch replacement with the E-vita OPEN NEO can be performed with excellent results in both the acute and chronic setting. This indicates that E-vita OPEN NEO can be used safely, including in the setting of acute type A aortic dissection.

Branch First Aortic Arch Replacement—An Emerging Approach to Tackling Acute Aortic Pathology

Branch First Aortic Arch Replacement—An Emerging Approach to Tackling Acute Aortic Pathology

Multi-center Experience With an Off-the-Shelf Single Retrograde Thoracic Branch Endoprosthesis for Acute Aortic Pathology

Multi-center Experience With an Off-the-Shelf Single Retrograde Thoracic Branch Endoprosthesis for Acute Aortic Pathology

Impact of acute aortic pathology care process reengineering on mortality of type A acute aortic syndrome

Abstract Funding Acknowledgements None. Introduction Type A Acute aortic syndrome (AAS) is a life-threatening disease. Although emergent surgery is the treatment of choice, these procedures are highly complex and require a high level of expertise. Process reengineering has demonstrated prognostic benefit in acute cardiovascular pathology. Purpose The aim of the present work is to assess whether the reorganization of AAS care has an impact on patient prognosis. Methods The "Aorta Code" (AC) is a protocol for AAS-patients’ care within a network of 4 hospitals with a tertiary hospital as a referral center. A common diagnostic algorithm was specifically designed and periodical training programs were carried out in the different emergency departments at the 4 hospitals. Once activated, the out of hospital emergency service immediately transfers the patient to the Acute Cardiovascular Care Unit at the referral center. An Aortic Dissection Team was responsible for patients’ care. Only two cardiac surgeons and two vascular surgeons performed all AAS surgeries. All patients with AAS were prospectively and consecutively collected and patients with type A AAS were selected for analysis. Expected 30-day mortality was calculated using the GERAADA score. Results From April-2019 to April-2023, 113 patients with AAS were included. Of them, 75.9% (83) were type A. 12% (10) of the patients died before reaching the operating theatre. In 9% (8) of the sample, surgery was rejected due to comorbidities and unacceptable surgical risk, of whom 4 patients died. Mean age was 66.7±13.7 years and 71% were males. Patients with type A AAS presented a significant burden of pre-surgical complications: severe aortic regurgitation (35.6%), cardiac tamponade (26.8%), shock (32.9%), cardiorespiratory arrest (8.5%), need for intubation (26.8%), acute renal failure (27%), peripheral malperfusion (12.7%) and myocardial ischemia (9.52%). Although the AC included a high risk AAS population, the process reorganization, and concentration of patients’ care in an experienced medical and surgical team resulted in a significant reduction of surgical mortality of patients with type A AAS compared to the expected mortality based on risk (figure). Conclusion AAS process reengineering and concentration of AAS management in an experienced medical-surgical team is associated with an improvement in the expected prognosis and mortality.Pre-surgical type A AAS complications.

Trilateral versus Bilateral Antegrade Cerebral Perfusion in Frozen Elephant Trunk: A Propensity Score Analysis.

Spinal cord injury (SCI) with subsequent paraplegia and/or stroke after arch repair with frozen elephant trunk (FET) remain the most devastating complications. In this study, we aim to examine the impact of different cerebral perfusion strategies on the neurological outcome comparing bilateral antegrade cerebral perfusion (bACP) and trilateral antegrade cerebral perfusion (tACP). Between 2009 and 2021, 88 patients underwent total arch replacement using a hybrid prosthesis in FET technique for acute (40.4%) and chronic (59.6%) aortic pathologies. After excluding 14 patients who underwent FET with unilateral ACP the remaining 74 patients were divided into two groups. Propensity score matching was performed based on pre- and perioperative patient characteristics resulting in 22 patients in each group. The primary endpoint was a combination of major cerebral event and SCI. Secondary end point was all-cause mortality. Major cerebral events occurred in 9% of the patients in bACP versus 13.6% in tACP group (p = 0.63). No postoperative SCI was observed in patients with bACP and only one patient suffered SCI with tACP (p = 0.31). There was no significant difference in 30-day mortality between the two groups (22.7% in bACP vs. 13.6% in tACP; p = 0.43). In patients undergoing total aortic arch repair using FET technique, both perfusion strategies (bilateral and trilateral ACP) are safe and effective. The rates of neurological complications as well as mortalities are acceptably low in both groups. Further studies with larger patient cohorts are warranted.

Early experience with the Gore TAG thoracic branch endoprosthesis for treatment of acute aortic pathology

The Gore TAG thoracic branch endoprosthesis (TBE) is the first Food and Drug Administration–approved device for zone 2 thoracic endovascular aortic repair, allowing for graft placement proximal to the left subclavian artery origin and maintaining vessel patency through a side branch. We describe our experience with the Gore TBE device in 20 patients for acute indications, including blunt thoracic aortic injuries, complicated dissections, and ruptured aneurysms. Technical success, with exclusion of pathology and left subclavian patency, was 100% without major complications within 30 days. Our early Gore TBE device experience demonstrates safe use in acute aortic pathology without an increased risk of complications.

Benchmarking a Center of Excellence in Vascular Surgery: Using Acute Physiology and Chronic Health Evaluation II to Validate Outcomes in a Tertiary Care Institute.

The Society of Vascular Surgery (SVS) has made it a top priority to implement verification of vascular "centers of excellence". Our institutional aortic network was established in 2008 in order to standardize care of patients with suspected acute aortic pathology. The implementation and success of this program has been previously reported. We sought to use our experience as a benchmark for which to develop prognostic modeling to quantify clinical status upon admission and help predict outcomes. Our objective was to validate the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system using a cohort of aortic emergencies transferred by an organized transfer network. This was a retrospective, single institution review of patients transferred through an institutional aortic network for acute aortic pathology from 2017-2018. Demographics, comorbidities, aortic diagnosis, APACHE II score, as well as 30-day mortality were recorded. Associations with 30-day mortality were evaluated using two-sample t-tests, ANOVA models, Pearson chi-square tests and Fisher exact tests. Receiver operating characteristic (ROC) curves were fit overall and by pathology to predict 30-day mortality by Apache II total score. There were 395 consecutive transfers were identified. The mean age was 64.7years. Diagnoses included Type A Dissection (n = 134), Type B (n = 81), Aortic Aneurysm (n = 122), and PAU/IMH (n = 27). Mean APACHE II score on arrival was 12. Overall there were 53 deaths (13.4%) in the cohort. Patients that died had significantly higher Apache II total scores (11.3 vs 16.5, P < .001). The area under the receiver operator characteristic (ROC) curve (AUC) was .66 for the full cohort, indicating a poor clinical prediction test. APACHE II score is a poor predictor of 30-day mortality in a large transfer network accepting all aortic emergencies. The authors believe further refining a prognostic model for diverse population will not only help in predicting outcomes but to objectively quantify illness severity in order to have a basis for comparison among institutions and verification of "centers of excellence".

Early Experience With the Gore TAG Thoracic Branch Endoprosthesis for Treatment of Acute Aortic Pathology

Early Experience With the Gore TAG Thoracic Branch Endoprosthesis for Treatment of Acute Aortic Pathology

Houston Methodist Ruptured Abdominal Aortic Aneurysm Guidelines.

Ruptured abdominal aortic aneurysm (RAAA) is an acute aortic condition that requires emergent intervention and appropriate continuity of care to optimize patient outcomes. We describe the standardized RAAA protocol at the Houston Methodist Hospital Acute Aortic Treatment Center, developed to navigate critical patient transfer periods safely and efficiently, make crucial decisions about surgical intervention, and clearly communicate these plans with other care team providers. Our workflow is organized into five phases: prehospital, preoperative, intraoperative, postoperative, and post-discharge. We identify the transfer center, anesthesia, operating room nursing staff, surgeons, and intensive care unit as key entities of our acute aortic pathology care team. This systematic protocol for the management of acute aortic emergencies such as RAAA identifies critical decision points, potential complications at each stage, and recommendations for best practice.

Role of advanced imaging techniques in cardiac surgery: Aortic dissection.

Collaboration among cardiac surgeons and radiologists is essential to fully leverage advanced imaging technologies and improve the care of cardiac surgery patients. In this review, a cardiac surgeon and cardiovascular radiologist discuss imaging pearls and considerations in aortic dissection cases. The surgeon and the radiologist discuss imaging considerations in two aortic dissection cases. It is essential to obtain and review all phases of a CTA when diagnosing acute aortic pathology. Optimizing scan parameters and careful multiplanar image review is necessary for adept interpretation. Current CT technology allows ECG gating to eliminate motion artifact and allow for dynamic assessment of the aortic pathology. Concurrent evaluation of thoracic aorta and coronary arteries is feasible. A systematic review of the scan using landmarks is critical for appropriate diagnosis and reporting. As TEVAR is increasingly used for arch repair, collaboration with radiologists is essential for preoperative planning in redo cases. Collaboration among cardiac surgeons and radiologists is mutually beneficial for surgeons, radiologists, and their patients.

Similarities, differences and unmet needs regarding prosthetic materials in aortic arch replacement using the frozen elephant trunk technique: a review.

The constant improvement of operative techniques offers the possibility of treating an increasing number of patients with complex acute and chronic thoracic aortic pathologies involving the aortic arch. Reliable and durable prosthetic material forms the platform for these approaches. Besides the most important properties like impermeability for blood, infection and thrombotic resistance, there are also properties which are not seen at first glance but can nevertheless play a key role in the healing process and long-term results, such as endothelialization and immunostimulation. To ensure the best possible properties of the graft, different variables of the grafts are continuously developed. Beside the choice of material and the weaving technique, Dacron sealing with gelatin is in clinical use for many years but is still being discussed. Collecting clinical experiences with sealed and unsealed grafts in aortic arch replacement led to the conclusion that blood loss through the prosthesis, especially in the early phase after the implantation of the graft, is lowered by gelatin sealing. Furthermore, binding of antimicrobiotic and antithrombotic agents to the collagen are promising approaches to a better prevention of these dreaded complications. More research examining the healing process of the prosthesis is needed in order to find out more about the influence of the prosthesis sealing.

Aortic dilatation using cardiac magnetic resonance in asymptomatic ELITE athletes

Abstract Funding Acknowledgements Type of funding sources: None. Purpose Aortic dilatation is associated with acute aortic pathology. Cardiac magnetic resonance (CMR) data in asymptomatic elite athletes is lacking. Therefore, we investigated the prevalence of aortic dilatation in a cohort of elite-level athletes using CMR. Methods We performed a cross-sectional study of aortic dimensions among elite-level (national-, international-, Olympic-, Paralympic-level or comparable) athletes. All athletes were asymptomatic and examined during pre-participation screening. Each underwent CMR with 3D whole heart in diastole (1.5 mm voxel) for aortic measurements, next to cine imaging, late gadolinium enhancement (LGE), and T1-mapping. We defined dilatation as 38 and 40 mm at the aortic root (sinus of Valsalva cusp-cusp), 27 and 31 mm at the sinotubular junction, and 23 and 26 mm at the level of the diaphragm, in male- and female athletes, respectively. Athletes were grouped for having 0- (normal), 1-, 2- or 3 measurements above cut-off values. Results We screened 156 athletes, 41% female, with a mean age (±SD) of 28±7 and body surface area (BSA) of 2.0±0.2 m2. Mean aortic dimensions were 33±4 mm for the sinus of Valsalva, 28±3 mm for the sinotubular junction, 20±3 mm for the aorta at diaphragm. We observed indexed end-diastolic volumes (EDVi) of 122±20 and 123±20 ml/m2, indexed end-systolic volumes (ESVi) of 53±13 and 54±16 ml/m2, stroke volumes (SV) of 129±36 and 126±39 ml, and ejection fractions (EF) of 56±5 and 55±6 %, in the left- (LV) and right ventricle (RV), respectively Fifty-three (34%) athletes, of which 45% female, had 1 or 2 aortic measurements above conventional cut-off values (Table 1). Eleven (7%), 18% female, had 2 aortic measurements above cut-off values. No athlete had all 3 measurements above cut-offs values. Athletes with 2 dilated measurements compared to athletes with 1 or 0 dilated measurements, had greater LV EDVi (145±19 vs. 119±18 vs. 120±19 ml/m2, p&amp;lt;0.001), greater RV EDVi (142±18 vs. 119±17 vs. and 122±20 ml/m2, p=0.002), greater LV ESVi (66±10 vs. 51±13 vs. 52±13 ml/m2, p=0.002), greater RV ESVi (66±10 vs. 53±13 vs. 53±17 ml/m2, p=0.039), greater LV SV (156±26 vs. 132±35 vs. 125±36 ml, p=0.020), and greater RV SV (152±25 vs. 130±34 vs. 121±41 ml, p=0.031), 2- vs, 1- vs. 0 dilated segments, respectively (Table 1, Figure 1). Athletes with dilated measurements had no LGE (excluding the hinge point), no difference in T1-mapping times, or LV- and RV EF, compared to athletes without dilated measurements. Conclusion One in three elite-athletes has dilatation in one or more aortic segments, including the sinus of Valsalva, sinotubular junction, or the aorta at diaphragm. Athletes with 2 dilated measurements (7%) had greater LV- and RV EDVi, ESVi, and SV, suggesting an association with ventricular volumes. Our findings in asymptomatic elite athletes, with normal EF and no LGE and comparable T1-mapping times, could be a sign of an outspoken physiological sports adaptation, instead of pathology.

Results of open thoracoabdominal aortic replacement in patients unsuitable for or after endovascular repair with remaining disease components.

OBJECTIVESOur goal was to evaluate outcomes in all-comer patients undergoing open thoracoabdominal aortic replacement either unsuitable for or after failed endovascular aortic repair.METHODSWithin a 4-year period, we analysed a consecutive series of 80 patients undergoing elective, urgent and emergency thoracoabdominal aortic replacement. Preoperative data, intraoperative data and outcomes were evaluated. Specific attention was given to technical refinements needed in patients after previous endovascular aortic repair.RESULTSEighty patients underwent thoracoabdominal aortic replacement: 11.3% (n = 9) had connective tissue disorders. Twenty-six patients (32.5%) had previous endovascular aortic repair and 54 (67.5%) did not have previous endovascular repair. The mean age was 64.2 ± 12 years, and 70% (n = 56) were male. The mean EuroSCORE was 7.9 ± 2.6. Urgent or emergency operations were done in 22.5% (n = 18). Overall mortality was 20% (n = 16); symptomatic spinal cord injury occurred in 5% (n = 4). We did not observe differences in survival according to the presence or absence of previous endovascular aortic repair (P = 0.524). Multivariate regression analysis revealed the amount of packed red blood cell units (P = 0.009, confidence interval 1.028–1.215, odds ratio = 1.117) as a predictor of in-hospital death. Follow-up was 100% (37.9 ± 15.8 months); freedom from aortic-related reintervention was 96.3%.CONCLUSIONSDespite an early attrition rate, survival after open thoracoabdominal aortic replacement is excellent, and freedom from aortic-related reintervention is high. Open surgery continues to remain an essential component in the treatment armamentarium of acute and chronic thoracoabdominal aortic pathology.

Risk factors for stroke after total aortic arch replacement using the frozen elephant trunk technique.

OBJECTIVESThis study aimed to analyse risk factors for postoperative stroke, evaluate the underlying mechanisms and report on outcomes of patients suffering a postoperative stroke after total aortic arch replacement using the frozen elephant trunk technique.METHODSTwo-hundred and fifty patients underwent total aortic arch replacement via the frozen elephant trunk technique between March 2013 and November 2020 for acute and chronic aortic pathologies. Postoperative strokes were evaluated interdisciplinarily by a cardiac surgeon, neurologist and radiologist, and subclassified to each’s cerebral territory. We conducted a logistic regression analysis to identify any predictors for postoperative stroke.RESULTSOverall in-hospital was mortality 10% (25 patients, 11 with a stroke). A symptomatic postoperative stroke occurred in 42 (16.8%) of our cohort. Eight thereof were non-disabling (3.3%), whereas 34 (13.6%) were disabling strokes. The most frequently affected region was the arteria cerebri media. Embolism was the primary underlying mechanism (n = 31; 73.8%). Mortality in patients with postoperative stroke was 26.2%. Logistic regression analysis revealed age over 75 (odds ratio = 3.25; 95% confidence interval 1.20–8.82; P = 0.021), a bovine arch (odds ratio = 4.96; 95% confidence interval 1.28–19.28; P = 0.021) and an acute preoperative neurological deficit (odds ratio = 19.82; 95% confidence interval 1.09–360.84; P = 0.044) as predictors for postoperative stroke.CONCLUSIONSStroke after total aortic arch replacement using the frozen elephant trunk technique remains problematic, and most lesions are of embolic origin. Refined organ protection strategies, and sophisticated monitoring are mandatory to reduce the incidence of postoperative stroke, particularly in older patients presenting an acute preoperative neurological deficit or bovine arch.

Imaging Information Overload: Quantifying the Burden of Interpretive and Non-Interpretive Tasks for Computed Tomography Angiography for Aortic Pathologies in Emergency Radiology

Over the past decade, technological advances have provided new tools for radiologists. However, the effect of these technological advances on radiologist workload and detecting pathologies needs to be assessed. The purpose of this study is to assess the workload, including non-interpretative tasks, associated with Computed Tomography Angiogram (CTA) of Aorta exams performed in the Emergency Department (ED) over a 10-year period and their relationship to detection of aortic pathology. This is a retrospective analysis of CTAs of Aorta performed on adults with suspected acute aortic pathology within the ED at an academic level I quaternary care hospital from January 1, 2005, through December 31, 2015. Data assessed included (1) Interpretive tasks: total number of images, number of reformat series, number of radiology reports with positive aortic pathologies; and (2) Non-interpretative tasks: recommendations and documentation of verbal communication with requesting providers. Statistical analyses were performed to assess temporal trends of variables. P values less than 0.05 are considered significant. A total of 4368 examinations (mean age: 69.8, M/F: 56.8%/43.2%) were performed. Studies per year increased significantly from 2005 (n=278) to 2007 (n=445), but not significantly after. The number of images and reformat series per scan increased from 487 to 2819 and 6.4 to 13.7, respectively (both P-value < 0.01). The proportion of exams with aortic findings did not significantly change (28.1% in 2005 and 24.9% in 2015). However, The proportions of exams with verbal communication increased from 9.3% to 24.6% and with recommendations from 1.8% to 28.9% (both P-value < 0.01). During a 10-year period, CTAs performed in the ED for suspected aortic pathology were associated with a significant increase in images created, reformat series generated, recommendations, and verbal communications with ordering providers without a concomitant increase in the rate of aortic pathologies. To completely capture the complexities of CTA workloads, non-interpretive tasks such as radiologist recommendations and verbal communications should also be included.

Mycotic abdominal aortic aneurysm caused by Borrelia afzelii: a case report

BackgroundInflammatory aneurysms and mycotic aneurysms make up a minority of abdominal aortic aneurysms. Mainly autoimmune mechanisms are proposed in the pathogenesis of inflammatory aneurysms, and it is not routine to check for infectious agents as disease culprits.Case presentationA 58-year-old European male with complaints of abdominal and back pain for 8 weeks was admitted after a semi-urgent computed tomography scan revealed an 85 mm inflammatory abdominal aortic aneurysm. The patient had normal vital signs, slightly elevated inflammatory markers, and mild anemia on admission. Clinical examination revealed a tender pulsating mass in his abdomen. His clinical condition was interpreted as impending rupture and urgent repair of the aneurysm was deemed necessary. Due to the patient’s relatively young age and aneurysm neck morphology, open aortic repair was preferred. Preoperatively, the aneurysm appeared inflamed, with fibrous wall thickening and perianeurysmal adhesions. Aneurysm wall biopsies were sent to histopathological and microbiological diagnostics. Routine cultures were negative, but 16S rRNA gene real-time polymerase chain reaction was positive and Borrelia afzelii was identified by DNA sequencing of the polymerase chain reaction product. B. afzelii was also identified by sequencing the polymerase chain reaction product of a Borrelia-specific groEL target. Immunoglobulin G and M anti-Borrelia antibodies were present on serological analysis. Histopathological analysis displayed loss of normal aortic wall structure and diffuse infiltration of lymphocytes and plasma cells. The patient had an uneventful recovery and was discharged after 1 week to a regional rehabilitation facility. Though the patient fares clinically well and inflammatory markers had normalized, antimicrobial treatment with doxycycline continues at 3 months follow-up due to remaining radiologic signs of inflammation.ConclusionsBorrelia infection in the setting of acute aortic pathology is a rare entity. To our knowledge, this is the first case report to demonstrate a mycotic abdominal aortic aneurysm as a rare manifestation of Lyme disease. Aortic wall biopsies and real-time polymerase chain reaction analysis of the specimen were essential for accurate diagnosis. This finding may contribute to the understanding of the etiology of inflammatory aneurysmal disease and abdominal aneurysms in general.

Первый опыт эндоваскулярного лечения острого расслоения аорты типа в по Стенфорду

Despite a large body of knowledge about acute thoracic aortic pathology, most physicians do not feel confidentin diagnosing and treating patients with this group of diseases characterized by high mortality. The emergenceof modern high-tech diagnostic methods, such as MSCT angiography, contributed to the early detection of bothacute and latent course of aortic pathology, as well as clearly determine the further treatment tactics. Currently,endovascular techniques are preferred in the treatment of acute thoracic aortic syndrome. This article presentsa case of successful endovascular treatment of acute aortic syndrome in our Republic.

In situ Laser Fenestrated Endografts to Treat Acute Aortic Pathology: A Single Centre Case Series

In situ Laser Fenestrated Endografts to Treat Acute Aortic Pathology: A Single Centre Case Series

Thoracic aortic aneurysm in pregnancy: morphological analysis of 6 cases

Aortic dissection is rare but life-threatening complication in pregnancy, causing significant maternal and perinatal losses. Pregnancy may influence the integrity of the vessel wall and is a risk factor for dissection. There are very few data in the literature on structural changes in the aortic walls during pregnancy complicated by aortic dissection. Aim. Study of pathological features in the wall of ascending aorta (AA) during or immediately after pregnancy is presented in the article. Materials and methods. Material after surgical correction of AA in patients during pregnancy and in the early postpartum period was studied. Frozen sections were made from one part of the sample, followed by hematoxylin and eosin (H&amp;E) staining, as well as Sudan III–IV staining to detect lipids. Paraffin sections were stained with H&amp;E and picrofuchsin (van Gieson’s stain) for differentiation of collagen and muscle fibers, as well as fuchselin (Weigert’s elastic stain). Results. Six cases of aortic surgery during pregnancy (n = 1) and postpartum period (n = 5) were included: severe aortopathy caused by Marfan syndrome (MS) (n = 3), aortic coarctation with bicuspid aortic valve (n = 1), renal hypertension (n = 1), and pregnancy-induced hypertension (n = 1). Pathohistological studies showed that in all patients who underwent aortic surgery at the end of the third trimester in the early postpartum period changes in aortic wall collagen structure were observed. In contrast, in a pregnant woman with MS and severe aortopathy, who underwent preventive aortic surgery at 19 weeks of gestation, there were no such changes, the morphologic samples showed areas of scarring. In all 6 cases signs of lipoidosis in the AA wall were observed. All these data require further theoretical study, but clinicians are already faced with the question of the feasibility of preventive surgery in women with severe aortopathy on the preconception stage or during pregnancy. Conclusions. The specific effect of pregnancy on the AA wall leads to collagen disruption and the appearance of lipoidosis in late pregnancy, which is an important pathomorphological substrate for the occurrence of acute aortic pathology.