Aortic Enlargement Research Articles

MYH11 rare variant augments aortic growth and induces cardiac hypertrophy and heart failure with pressure overload.

Smooth muscle cell-specific myosin heavy chain, encoded by MYH11, is selectively expressed in smooth muscle cells (SMCs). Pathogenic variants in MYH11 predispose to a number of disorders, including heritable thoracic aortic disease associated with patent ductus arteriosus, visceral myopathy, and megacystis-microcolon-intestinal hypoperistalsis syndrome. Rare variants of uncertain significance occur throughout the gene, including MYH11 p.Glu1892Asp, and we sought to determine if this variant causes thoracic aortic disease in mice. Genomic editing was used to generate Myh11E1892D/E1892D mice. Wild-type (WT) and mutant mice underwent cardiovascular phenotyping with and without transverse aortic constriction (TAC). Myh11E1892D/E1892D and WT mice displayed similar growth, blood pressure, root and ascending aortic diameters, and cardiac function up to 13 months of age, along with similar contraction and relaxation on myographic testing. The hypertension induced by TAC induced was similarly in Myh11E1892D/E1892D and WT mice, but mutant mice showed augmented ascending aortic enlargement and increased elastic fragmentation on histology. Unexpectedly, male Myh11E1892D/E1892D mice undergoing TAC had decreased ejection fraction, stroke volume, fractional shortening, and cardiac output compared to similarly treated male WT mice. Importantly, left ventricular mass increased significantly due to primarily posterior wall thickening, and cardiac histology confirmed cardiomyocyte hypertrophy and increased collagen deposition in the myocardium and surrounding arteries. These results further highlight the phenotypic heterogeneity associated with MYH11 rare variants. Given that MYH11 is selectively expressed in SMCs, these results implicate a role of SMCs in the arteries of the heart contributing to cardiac hypertrophy and failure with pressure overload.

Anatomic and operative predictors of aortic expansion following aortic dissection repair

Following surgical repair of acute type A aortic dissection(ATAAD), distal aortic degeneration and growth may occur. Previous evidence has suggested that false lumen(FL) communications and flow may influence postoperative aortic remodeling, although the contribution of branch vessel dissection and FL communications is unclear. Patients who underwent ATAAD repair from 2017 to 2023 at a single center with at least 1 year of follow-up imaging were included in this study. Patients were grouped based on aortic pathology and surgical repair. Preoperative and postoperative measurements were taken at the level of zone 1 and between zones 4/5. 63 patients were included in this study. 87.3% received a hemiarch repair, 34.9% received hemiarch + AMDS Hybrid prosthesis, and 12.7% received a total arch replacement. Proximal aortic remodeling was not reliably predicted by the presence of FL communications or surgical approach. Distal aortic growth was independently associated with ≥ 3 or 4 visceral vessel dissections(p = 0.04 − 0.005). In conclusion, distal aortic remodeling following ATAAD repair was predicted by visceral vessel involvement. While the aortic arch is often emphasized at the time of ATAAD repair, features of the distal aorta may help to risk stratify patients for long-term adverse events, helping to guide initial management and post-ATAAD repair follow-up.

Surgical vs. Medical Management of Infective Endocarditis Following TAVR: A Systematic Review and Meta-Analysis

Background: Infective endocarditis after transcatheter aortic valve replacement (TAVR-IE) is a rare but severe complication associated with high morbidity and mortality. The optimal treatment strategy—surgical explantation versus medical therapy—remains uncertain, particularly given the technical demands of TAVR removal and the advanced age of many affected patients. Methods: We conducted a systematic review and meta-analysis of studies comparing the surgical and medical management of TAVR-IE. Primary outcomes included 30-day mortality and 1-year survival. Secondary analyses explored microbiological profiles, patient demographics, prosthesis type, postoperative complications, and surgical indications. A qualitative synthesis of surgical explantation techniques and reconstructive strategies was also performed based on recent consensus recommendations. Results: Three studies comprising 1557 patients with TAVR-IE were included; 155 (10.0%) underwent surgical treatment. Thirty-day mortality was comparable between groups (surgical: 9.7%; medical: 8.4%), while the pooled odds ratio for one-year survival did not reach statistical significance (OR: 1.91, 95% CI: 0.36–10.22; I2 = 88%). However, single-center outcomes demonstrated markedly improved survival with surgery (96% vs. 51%). The most common surgical indications included severe valvular dysfunction (50.3%), aortic root abscess (26.5%), and large vegetations (21.3%), in line with current guideline recommendations. Postoperative complications included acute renal failure (10%) and longer hospitalizations (19.8 vs. 18 days), although these were not statistically different. Contemporary explant strategies—such as the Double Kocher, Tourniquet, and Y-incision aortic enlargement techniques—were highlighted as critical tools for surgical success. Conclusions: While underutilized, surgical intervention for TAVR-IE may offer significant survival benefits in select patients, particularly when guided by established indications and performed at high-volume centers. Outcomes depend heavily on timing, surgical expertise, and appropriate patient selection. As TAVR expands to younger populations, TAVR-IE will become increasingly relevant, necessitating early multidisciplinary involvement and broader familiarity with advanced explant techniques among cardiac surgeons.

Pulmonary artery and aortic enlargement predict postoperative survival outcomes in lung cancer.

The pulmonary artery/aorta ratio can predict postoperative outcomes in patients with lung cancer; however, few studies have investigated the effects of individual changes in the pulmonary artery and aortic diameters. This study aimed to analyse the impact of pulmonary artery and aortic enlargement on outcomes following surgery for lung cancer. We retrospectively analysed data from 1482 patients with non-small-cell lung cancer who underwent radical surgery at our institution between 2006 and 2022. The maximum diameters of the pulmonary artery and ascending aorta were measured using preoperative computed tomography, and patients were divided according to cutoff values set for the receiver operating characteristic curve. All patients were then stratified into three groups: non-enlarged pulmonary artery and aorta ('normal' group, n = 244), enlargement of either the pulmonary artery or aorta ('either enlargement' group, n = 689) and enlargement of both the pulmonary artery and aorta ('both enlargement' group, n = 549). The preoperative clinical characteristics and postoperative outcomes were analysed in these three groups. Five-year overall survival rates in the 'normal', 'either enlargement' and 'both enlargement' groups were 80.2%, 77.3% and 71.0% (P = 0.002), respectively. Enlargement of both vessels was an independent negative prognostic factor for both overall survival (hazard ratio, 1.56; P = 0.04) and cancer-specific death (hazard ratio, 1.83; P = 0.03). However, this association was not significant for non-cancer-specific deaths (hazard ratio, 1.39; P = 0.35). Measurement of the pulmonary artery and aortic diameters might be a useful predictor of postoperative survival in patients with lung cancer.

Surgeon Frequency of Aortic Root Enlargement and Long-Term Survival in Medicare Beneficiaries Undergoing Surgical Aortic Valve Replacement.

Surgeon Frequency of Aortic Root Enlargement and Long-Term Survival in Medicare Beneficiaries Undergoing Surgical Aortic Valve Replacement.

Resolving the design principles that control post-natal vascular growth and scaling.

Resolving the design principles that control post-natal vascular growth and scaling.

Predictive ability of red blood cell distribution width for negative remodeling of type B aortic dissection.

Predictive ability of red blood cell distribution width for negative remodeling of type B aortic dissection.

Aortic annulus reconstruction with bovine pericardium during aortic valve replacement for severe calcific aortic stenosis

ObjectiveTo explore the application and effect of aortic annulus reconstruction (AAR) with bovine pericardium during surgical aortic valve replacement (SAVR) for severe calcific aortic stenosis (AS).MethodsWe retrospectively reviewed 12 patients with severe calcified AS who underwent bovine pericardium aortic annulus reconstruction between January 2021 to December 2023. The average age of the patients was 58 ± 8.8 years. All patients were diagnosed with severe AS, along with aortic valve and annulus calcification, through chest computed tomography (CT) and transthoracic echocardiography (TTE) prior to surgery. After the resection of severely calcified aortic annulus tissue, all patients were given a bovine pericardial patch to repair the annular defect, and five of these patients underwent Y-incision aortic annular enlargement (AAE). The patients were followed up for a duration of 0.5 to 2 years.ResultsA total of 12 patients undergoing SAVR were enrolled, and all received bovine pericardial patches to repair the annular defects, with a mean preoperative indexed effective orifice area (iEOA) of 0.58 ± 0.098 cm²/m². The average extracorporeal circulation time during the operation was 150.83 ± 34.5 min, and the average cross-clamp time was 95.42 ± 17.46 min. Postoperative evaluations indicated that the structural integrity of the valve annulus remained intact, demonstrating hemodynamic stabilization without any recorded fatalities among participants. Compared to preoperative levels, the aortic valve mean gradient (4.67 ± 1.15 vs. 59.67 ± 17.94 mmHg, P < 0.001), peak gradient (13 [10-15.75] vs. 92 [82.25-110.25] mmHg, P < 0.001), mean aortic jet velocity (99.67 ± 15.44 vs. 367.17 ± 58.13 cm/s, P < 0.001), and peak aortic jet velocity (182.25 ± 23.40 vs. 495.67 ± 61.74 cm/s, P < 0.001) significantly decreased after 0.5 years of follow-up. There were no complications such as hemolysis, perivalvular leakage, thrombosis or endocarditis during follow-up.ConclusionIn patients with severe calcified AS, the AAR technique using bovine pericardium during SAVR is safe and effective, with stable hemodynamic performance and satisfactory clinical outcomes.

Modeling the Hemodynamic Impact of Y-incision Aortic Annular Enlargements on Aortic Valve Replacement and Valve-in-Valve Procedures.

Y-incision aortic annular enlargement (Y-AAE) with surgical aortic valve replacement (SAVR) may improve outflow tract hemodynamics and valve-in-valve (ViV) outcomes but could increase thrombosis risk. We used computational fluid dynamics to analyze post-operative hemodynamics in 15 patient-specific SAVR models, comparing cases with and without Y-AAE. ViV scenarios were simulated by virtually deploying transcatheter aortic valves. Transvalvular peak velocities, pressure gradients, and blood residence time (a proxy for hemostatic risk) were analyzed to assess performance across cases. Y-AAE reduced peak velocity by 39.3% (55% in ViV), transvalvular pressure gradient by 87.2% (92% in ViV), and mean blood residence time by 10.3% (14% in ViV), with no consistent difference in maximum residence time. SAVR with Y-AAE demonstrated improved hemodynamics, even with ViV procedures, and no evidence of increased thrombosis risk.

Desbuquois dysplasia and cardiovascular complications: a retrospective cohort study

Desbuquois dysplasia (DBQD) is a rare autosomal recessive chondrodysplasia characterized by distinct skeletal abnormalities and multisystem involvement. Cardiac manifestations, such as aortic root dilatation and mitral valve prolapse, have also been reported, likely due to impaired proteoglycan production. This study aims to enhance the understanding of clinical management and cardiac implications in patients with DBQD, contributing to the broader knowledge of this rare condition. This research was conducted at Hacettepe University İhsan Doğramacı Children’s Hospital, a tertiary reference center for all pediatric subspecialties. A single-center, descriptive, retrospective cohort study was performed. Demographic characteristics, genetic mutations, echocardiographic findings, and measurements of patients with Desbuquois dysplasia were documented. A total of nine patients, including five females (55%) were included in the study. The median age of the patients was 11 years (range 3.6–23.6 years), the median body weight was 15 kg (6–64 kg), and the median height was 94 cm (63–130 cm). The median follow-up period was 7.7 years (range 2.9–15.4 years). All patients had homozygous or compound heterozygous pathogenic variants in the CANT1 gene. The most common cardiac findings included mitral valve prolapse (seven patients, 77%), ascending aortic dilatation (seven patients, 77%), aortic root enlargement (six patients, 66%), small atrial septal defect (ASD) (five patients, 55%), bicuspid aortic valve (two patients, 22%), and ventricular septal defect (VSD) (one patient, 11%). Additionally, coronary-cameral fistula, a rare finding in the general population, was observed in one patient. The median individual Z scores for the sinus valsalva (SVS) in patients with aortic dilatation were 4.9 (range 2.7–7.5), while the median Z score in the ascending aorta was 5 (range 2.3–8.5). Conclusion: Aortic root and ascending aorta dilatation as well as mitral valve prolapse are frequently observed in patients with DBQD. ASD, VSD, and bicuspid aorta are less common. Aortopathy develops early and can progress to a severe stage. Early detection of cardiac abnormalities and timely initiation of medical treatment may significantly improve the long-term prognosis of the disease.What is Known:• Desbuquois dysplasia (DBQD) is a rare autosomal recessive chondrodysplasia characterized by distinct skeletal abnormalities and multisystem involvement. Cardiac manifestations, such as aortic root dilatation and mitral valve prolapse, have also been reported, likely due to impaired proteoglycan production.What is New:• The most frequently observed findings include aortic root and ascending aortic dilatation as well as mitral valve prolapse. Aortopathy develops early and can progress to severe disease. Early detection of cardiac abnormalities and timely initiation of medical treatment may significantly improve long-term prognosis.

Aortic Annular Enlargement: Y-Incision Rationale, Technique, and Outcomes.

Aortic Annular Enlargement: Y-Incision Rationale, Technique, and Outcomes.

Beyond Endovascular Solutions: Open Sac Revision with Graft Preservation for Persistent Aortic Sac Expansion Post-EVAR.

Beyond Endovascular Solutions: Open Sac Revision with Graft Preservation for Persistent Aortic Sac Expansion Post-EVAR.

One-year outcomes from the pivotal trial of a four-branch off-the-shelf solution to treat pararenal and extent IV thoracoabdominal aortic aneurysms.

One-year outcomes from the pivotal trial of a four-branch off-the-shelf solution to treat pararenal and extent IV thoracoabdominal aortic aneurysms.

The correlation between obstructive sleep apnea-hypopnea syndrome and postoperative distal expansion of Type A aortic dissection.

The correlation between obstructive sleep apnea-hypopnea syndrome and postoperative distal expansion of Type A aortic dissection.

Surgical Explantation of Stenotic Self-Expandable Transcatheter Aortic Valve with Aortic Root Enlargement

Surgical Explantation of Stenotic Self-Expandable Transcatheter Aortic Valve with Aortic Root Enlargement

71543 | SAVR With Y-Incision Aortic Annular Enlargement Outperforms TAVR in Hemodynamics in Women With Native Aortic Stenosis

71543 | SAVR With Y-Incision Aortic Annular Enlargement Outperforms TAVR in Hemodynamics in Women With Native Aortic Stenosis

Comparative study of aortic root replacement versus aortic root enlargement in small aortic root

BackgroundFor patients with aortic stenosis (AS) and small annulus, aortic root replacement (RR) and aortic root enlargement (RE) are proven methods to prevent prosthesis-patient mismatch (PPM). Our goal was to compare the results of those two categories of operations. This prospective study used our hospitals’ database of aortic valve replacements from 2021 to 2024. Patients who had aortic stenosis treated with RE or RR were compared. The postoperative results and reoperations were compared. Kaplan–Meier survival estimation and log-rank test were used to compare time-to-event data.ResultsA total of 72 patients had aortic stenosis treated with either RE or RR. Thirty-eight (52%) and 34 (47%) patients underwent RR and RE, respectively. In RR cases, significant postoperative bleeding was noted in 13 patients vs. only 4 patients in RE group (P-value = 0.001). The length of stay did not differ significantly (P-value = 0.918) in both groups and the same in early postoperative mortality (2.6% for the RR group vs. 5.9% for the RE group (P = 0.17)). Additionally, there were no considerable variations in the reoperation rate (2.6% in RR cases vs. 2.9% in RE cases). Patients in the RR group had lower trans-prosthetic gradients and larger valves implanted (P < .001). The median follow-up period was 24.5 (25th–75th percentiles: 1–48) months. Kaplan–Meier survival estimates for the two groups were similar and did not show a significant difference in mortality.ConclusionsAortic valve reoperations, 4-year survival, and postoperative complications were all similar for AS patients treated with RE and RR. The study showed comparable reoperation rate, postoperative complications and survival rates between root replacement and enlargement in patients with small aortic root.

Steal Phenomenon of Thoracic False Lumen: Imaging Insights From Postdissection Cases

Persistent thoracic false lumen flow and subsequent aortic expansion are common complications following thoracic endovascular aortic repair for type B aortic dissection, as well as aortic arch replacement with the elephant trunk technique for type A aortic dissection. Although thoracic false lumen-perfused branches are known to contribute to thoracic false lumen backflow, robust imaging evidence is still lacking. This review illustrates how these branches perpetuate thoracic false lumen flow through detailed imaging analysis, emphasizing the critical need for advancing rapid, accurate, and minimally invasive imaging techniques and novel therapeutic devices to address this persistent clinical challenge.

Thoracic radiographic findings of canine spirocercosis in Australia.

Canine spirocercosis in Australia has been poorly described in the veterinary literature. The objectives of this multicentre retrospective case series were to increase the awareness of veterinarians (including teleradiology providers) regarding Spirocerca lupi in Australia and to describe the thoracic radiographic findings of dogs infected with S. lupi with comparison to other endemic regions. Fifty-nine dogs with a diagnosis of canine spirocercosis were recruited from veterinary practices located in subtropical and tropical Australia. Many (54/59; 92%) originated from Mount Isa, Queensland, due to proactive screening. Thoracic radiographs identified 42 oesophageal masses in 35/59 (59%) of affected dogs. Identification of oesophageal masses was nearly always facilitated by oesophageal gaseous distension after gastro-oesophageal endoscopy, sedation or anaesthesia (33/35, 94%). Oesophageal masses were most frequently centred at T8. Where the aorta was visualised, aortic enlargement was detected in 17/42 (40%) dogs. Spondylitis was frequently detected (32/59; 54%) and most frequently located at T8-11. Spondylosis deformans was less frequently detected (14/59; 24%) but in 7/14 (50%) studies it was present concurrently with spondylitis. Spondylitis had varied morphological features, some of which were contrary to previously reported definitions. Despite this, the radiographic appearance of spondylitis allowed relatively reliable differentiation from spondylosis deformans and added significant confidence to the radiographic diagnosis of spirocercosis. Pleural effusion (5/59; 8%) was the most frequent additional radiographic finding. In conclusion, thoracic radiographic findings of canine spirocercosis in Australia are similar to other endemic regions and S. lupi is present in multiple regions of Australia not previously reported.

Technical and Clinical Outcomes of 13years of Endovascular Repair of Infrarenal, Atherosclerotic, Penetrating Aortic Ulcers.

To report the technical and clinical outcomes of endovascular repair of all infrarenal, penetrating aortic ulcers (PAUs) that were treated at a single institution over a 13-year period. This is a single-center, retrospective observational study. All patients consecutively treated for atherosclerotic, infrarenal PAU were included between 2010 and 2023. Outcomes were technical success, overall survival, PAU-related death, freedom from secondary rupture, freedom from secondary interventions, freedom from aortic expansion >5mm, freedom from type 1 and type 3 endoleak (EL), and freedom from stent graft migration, each at 30days, 1year, 2years, and 5years of follow-up. The study was registered at the German Clinical Trials Register (DRKS00028794). Forty-seven patients were included (8 female patients, 17.0%) with a median age of 75.7years (interquartile range (IQR): 70.2-81.0). The median maximum aortic diameter was 39.7mm (IQR: 33.6-45.2). Overall, primary and secondary technical success was achieved in 42 of 47 (89.4%) and 46 of 47 patients (97.9%). Standard aortobiiliac endovascular aneurysm repair (EVAR) was the most frequent procedure in 25 patients (53.2%). An aortomonoiliac stent graft system was used in 5 patients (10.6%). The remaining 17 patients (36.2%) were treated using an aorto-aortic tube stent graft configuration. The median clinical follow-up was 5.1years (IQR: 1.9-8.1) with a median imaging follow-up of 1.5years (IQR: 0.4-5.0). Overall survival at 30days, 1, 2, and 5years of follow up was estimated at 100% (confidence interval (CI), 100%-100%), 95.4% (CI, 89.4%-100%), 87.9% (CI, 78.4%-98.4%), and 82.0% (70.7%-95.2%), respectively. There was 1 PAU-related death (2.1%). Freedom from secondary intervention at 30days, 1, 2, and 5years of follow-up was 93.6% (CI, 86.9-100%), 89.2% (CI, 80.6-98.6%), 81.5% (CI, 70.7-94.0%), and 75.2% (CI, 62.8-90.2%), respectively. No patient who underwent either preoperative (n=1) or intraoperative embolization (N=7) of lumbar arteries (LAs) and/or the inferior mesenteric artery (IMA) demonstrated type 2 EL during follow-up. A variety of alternatives to standard aortobiiliac EVAR are required for endovascular PAU repair. To identify the optimal management strategy in these cases further studies are needed. Type 2 EL in abdominal PAU disease appears to be preventable by LA and/or IMA embolization.