Aneurysm Of Ascending Aorta Research Articles

Transforming growth factor-β1 SMAD effectors and medial cell number in ascending aorta diseases

In ascending aorta aneurysms and dissections, the extracellular matrix is degraded. Transforming growth factor (TGF)-β1 modulates its synthesis. The production and presence of SMADs, intracellular effectors of TGF-β1 signaling, were analyzed in patients with these diseases. To verify whether medial cells are lost, their total numbers were computed. Ascending aorta samples from 19 patients and 18 controls underwent immunoperoxidase reactions to SMADs 2, 3, 4, and 7. Positive and negative cells were counted, and total numbers of cells and positive/total ratios were calculated. Samples from other 14 patients and 7 normal controls were used for the quantification of SMAD3, SMAD4, and SMAD7 mRNA. For SMAD4, both mRNA (2.36 vs. 0.37, P=.03) and ratio of positive cells (0.94 vs. 0.73, P=.02) are increased in patients with ascending aortic diseases. SMAD3 mRNA was also increased (1.19 vs. 0.20, P=.05). The cell ratios of this and the other SMADs, SMAD7 mRNA, and the total cell count did not differ between groups. In conclusion, in ascending aortic aneurysms and dissections, there is an increase in SMAD4, implicated in extracellular matrix production, possibly as an attempt to compensate for extracellular matrix deficiency. Lost medial cells are replaced, since their number is not diminished.

Detailed Measurement of Wall Strain with 3D Speckle Tracking in the Aortic Root: A Case of Bionic Support for Clinical Decision Making

Three-dimensional (3D) wall motion tracking (WMT) based on ultrasound imaging enables estimation of aortic wall motion and deformation. It provides insights into changes in vascular compliance and vessel wall properties essential for understanding the pathogenesis and progression of aortic diseases. In this report, we employed the novel 3D WMT analysis on the ascending aorta aneurysm (AA) to estimate local aortic wall motion and strain in case of a patient scheduled for replacement of the aortic root. Although progression of the diameter indicates surgical therapy, at present we addressed the question for optimal surgical time point. According to the data, AA in our case has enlarged diameter and subsequent reduced circumferential wall strain, but area tracking data reveals almost normal elastic properties. Virtual remodeling of the aortic root opens a play list for different loading conditions to determine optimal surgical intervention in time.

Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis.

The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence.

Assessment of myocardial performance index and its association with aortic elasticity in patients with ascending aortic aneurysm.

Ascending aortic aneurysms (AAA) are a leading cause of morbidity and mortality. Nevertheless, their effects on global cardiac functions are yet to be fully understood. Myocardial performance index (MPI) has been widely used to quantitatively assess myocardial functions. The aim of this study was to evaluate left ventricular (LV) functions in patients with AAA using tissue Doppler (TD) echocardiography and MPI in addition to conventional echocardiographic methods. Fifty patients with AAA (33 men, 17 woman; mean age 55.5±7.90 years) were included, and 106 patients without aortic dilatation (mean age 54.1±8.18 years) were included as the control group. LV systolic and diastolic functions were analyzed using 2-dimensional, M-mode, and TD echocardiography. Patients with AAA had significantly higher MPI (0.5±0.04 vs 0.4±0.05, p<0.001), TD-MPI (0.5±0.02 vs 0.4±0.03, p<0.001), and reduced aortic elasticity, as indicated by reduced aortic distensibility (AD) (1.7±1.27 vs 3.1±1.25, p<0.001). Multivariate linear regression analysis showed that TD-MPI was independently correlated with reduced aortic distensibility (B=-0.006, p=0.019, 95% confidence interval,-0.011 to -0.001). MPI and TD-MPI indicated impairment of global cardiac functions in patients with AAA, which may be attributed to reduced aortic elasticity.

Single-Stage Repair of a Critical Aortic Coarctation, a Bicuspid Aortic Stenosis and an Ascending Aortic Aneurysm

We report a 26-year-old man with critical aortic coarctation, severe bicuspid aortic valve stenosis, infective endocarditis and ascending aortic aneurysm. He underwent simultaneously in singlestage a Bentall’s procedure and an extra-anatomic ascending-descending aortic bypass grafting by 14-mm Dacron tube, through median sternotomy. The immediate postoperative outcome was favourable. The CT scan control for 7 years after surgery showed a good patency of the extra-anatomic bypass.

Role of Cardiac Computed Tomography in the Evaluation of Coronary Artery Stenosis in Patients With Ascending Aorta Aneurysm Detected at Transthoracic Echocardiography.

The aim of our study was to evaluate the diagnostic performance of cardiac computed tomography (CCT) in the evaluation of coronary artery stenosis in patients with ascending aorta aneurysm detected at transthoracic echocardiography. We conducted a retrospective analysis of patients with an aneurysm 45 mm or greater at transthoracic echocardiography who underwent CCT from 2012 to 2014 in our hospital. We calculated the sensitivity, specificity, and positive and negative predictive values of CCT for the assessment of coronary artery stenosis (<50% or ≥50% stenosis) in patients who underwent conventional coronary angiography. We included 104 patients (73 men, aged 64 [SD, 10.8] years) in our study. Obstructive coronary artery disease was found in 22.1% of patients. Sensitivity, specificity, and positive and negative predictive values of CCT for detecting significant stenoses were 100%, 98%, and 82% and 100% on a segment-by-segment analysis and 100%, 83%, and 65% and 100% on a per-patient analysis, respectively. Cardiac computed tomography provides a comprehensive evaluation of ascending aorta aneurysms and coronary artery tree.

Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome

A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

0368: Radiation in transfemoral versus transradial access in diagnostic coronary angiography

Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure as compared to transfemoral access (TFA). The aim of this study is the comparison of radiation exposure parameters between coronary angiography procedures performed via left radial artery, right radial artery or femoral artery and the detection of factors that contribute to increased radiation dose. We analysed collected data on radiation exposure for a total of 733 consecutive diagnostic coronary angiographies (69% in men) excluded those concerning patients with aortocoronary bypass grafts or those accompanied by aortography or ventriculography. Dose area product (DAP) and fluoroscopy time (FT) were used as a means of radiation exposure measurement. The mean patients’ age was 66.8±10.1 years and BMI 28.4±4.6kg/m 2 . Femoral access was used in 45% of the procedures, right radial access (RRA) in 42% and left radial access (LRA) in 13%. More diagnostic catheters were used via TFA than TRA (2.24±0.63 vs 1.94±0.83 respectively, p<0.001); LRA was associated with the use of more diagnostic catheters than RRA. TRA was associated with increased FT (4.8±3.5 vs 3.1±2.4 min, p<0.001 but there was no difference regarding FT between RRA and LRA. Hypertension and the presence of ascending aorta aneurysm were predictors of increased exposure parameters, especially in TRA, whereas diabetes mellitus was predictor of increased DAP. The use of 1 or 2 diagnostic catheters was associated with reduced DAP and FT. TRA is associated with increased FT. Hypertension and ascending aorta aneurysm are adversely affecting exposure parameters. With TRA and especially RRA is feasible the use of fewer diagnostic catheters in patients undergoing diagnostic coronary angiography.

Surgery for Acute Stanford Type A Aortic Dissection in an Inner City Community Hospital: Single Surgeon’s Experience

Objective: An inverse relationship between volume and mortality in some cardiothoracic surgical procedures has been previously established, leading to suggestions that acute aortic dissection should not be operated in community or low volume heart centers. We therefore reviewed our experience to compare with published data. Methods: Retrospective review of 27 patients who underwent proximal aortic surgery by a single surgeon at an inner city community hospital between May 2004 and April 2015. 16 patients, mean age 51.7 ± 13.6 years old, 75.0% males underwent emergency surgery for acute Stanford type A aortic dissection, while 9 with root or ascending aortic aneurysm, mean age 50.3 ± 15.0 years old, 88.9% males had elective proximal aortic surgery. 2 patients with arch aneurysm were excluded. Results: Four (25.0%) patients with acute dissection were in Penn class A, 3 (18.7%) Penn B, 3 (18.7%) Penn C and 6 (37.5%) Penn B+C. 10 (62.5%) patients underwent emergency root replacement with 60.0% (6/10) mortality all related to malperfusion including 2 patients with bloody stools, while 6 (37.5%) underwent supracoronary graft replacement with 16.6% (1/6) mortality from cardiac tamponade. The 5-year survival was 89.0%. In patients with aortic aneurysm, 8 (88.9%) underwent elective root replacement and 1 (11.1%) supracoronary graft replacement with zero mortality. Conclusion: Supracoronary graft replacement is performed for the majority of uncomplicated acute type A dissections and can be undertaken by the average general cardiac surgeon with acceptable results. Visceral malperfusion especially when associated with bloody stools portends a poor prognosis, and aortic dissection should be excluded in any Marfan patient presenting with acute abdomen. Delaying intervention in attempting transfer to a tertiary hospital can potentially increase preoperative mortality, known to rise with each passing hour from onset of acute dissection. Patients presenting therefore to community hospitals should probably undergo surgery there to avoid complications associated with delay.

Giant Ascending Aortic Aneurysm Complicated by a Tracheal Compression: A Case Report and Review of the Literature

We present an uncommon case report of a giant ascending aortic aneurysm with a maximal diameter of 13.97 cm, in a previously asymptomatic and healthy 77 year old female patient, presenting with sudden dyspnea. The patient underwent an emergent surgical repair by a Bentall operation under circulatory arrest. But she died in the postoperative period with multi-organ impairment.

The role of extracellular and intracellular proteolytic systems in aneurysms of the ascending aorta.

Aneurysms of the ascending aorta are an outstanding challenge to clinicians as they may persist asymptomatic until they present with dissection or rupture. Intensive research is performed to reveal the molecular mechanisms causing aneurysm formation. Calpains are ubiquitous non-lysosomal cysteine proteases which are classically activated by calcium signaling. The two major forms of the calpain-family are calpain-I and calpain-II. Calpastatin specifically inhibits the proteolytic activity of calpain-I and -II. Recently it has been demonstrated in aneurysm tissues from ascending aortas obtained from Marfan syndrome patients that calpain-II expression is increased and calpastatin expression is decreased. Thus, we were interested in the probable role of calpains in aneurysms of ascending aorta in non-Marfan patients. Therefore, ascending aortic samples of dilated and non-dilated aortas were analyzed according to their calpain-I, -II and calpastatin content as well as the expression levels of MMPs and elastin as well as the infiltration of inflammatory cells. We have found significant differences in calpain-I and calpastatin protein expression and serum levels in patients with aneurysm of the ascending aorta. Furthermore, MMP-1 and MMP-3 expression levels correlate with calpain-I protein levels. Due to our findings we conclude that calpain-1 seems to be related to fibrotic alteration in aortic aneurysm tissue in our experimental group. The change in calpain-1 modulates the structure of aortic tissue causing alteration in elastin structure, thus enabling macrophage infiltration and elevation of MMP levels. Circulating levels of calpain-1 may be used as a prognostic marker in the future if further correlation analyses are done.

Abstract 16827: Double-chambered Right Ventricle Diagnosed in Late Adulthood by Multi-modality Imaging. Report of Two Cases With Associated Aortopathy

Introduction: Double-chambered right ventricle (DCRV) is a rare congenital disorder. The right ventricle (RV) is divided into two: a high-pressure inlet and a low-pressure outlet by an abnormal muscle bundle. Rarely diagnosed in adulthood, it is associated with other congenital defects. Association with aortopathy is not described. Patient 1: 67 year-old male with dyspnea: PE: grade 4 harsh systolic murmur radiating to the base. Echo: DCRV with obstruction -peak gradient (PG) 75mmHg (Fig 1-C), hypertrophied/dilated RV, decreased function; small perimembranous VSD, small right-to-left shunt. Ascending aorta aneurysm: 49 mm (Fig 1-D). Normal aortic valve. MRI: DCRV with muscle bundle causing RVOT obstruction. RV with delayed gadolinium enhancement (Fig 2). Heart cath: severe RV obstruction (PG 105 mmHg). Surgery: Resection of the muscular bundle, VSD closure and grafting of ascending aorta. Follow-up: significant improvement. Patient 2: 56 year-old female with VSD. PE: 4/6 holosystolic murmur at left sternal border. Echo: DCRV: Mean gradient (MG) 30 mmHg (Fig 1-B), small perimembranous VSD. Ascending aorta: 39 mm. Functionally bicuspid aortic valve, mild AR. Exercise echo: sub-pulmonary resting MG 35, stress MG 52 and PG 90 mmHg. MRI: DCRV with a membrane causing RVOT stenosis. Gene testing for TAAD/Marfan negative. Surgery: VSD closure and resection of RV membrane. Follow up: asymptomatic. Conclusion: DCRV should be considered with an elevated RV systolic pressure and intracavitary gradient. Comprehensive echocardiographic examination of the RV is essential. CMR is useful providing anatomic detail. Surgical correction has successful short and long term outcomes.

Abstract 17361: Loss of Notch1 in the Secondary Heart Field Exacerbates Ascending Aortic Aneurysm and Causes Aortic Rupture in Marfan Syndrome Mice (Best of Basic Science Abstract)

Ascending aortic aneurysm (AscAA) is a life-threatening disease that affects approximately 3.5 in 100,000 people per year, but the mechanisms of AscAA remain poorly understood. We previously reported that NOTCH1 mutations are associated with familial bicuspid aortic valve (BAV), and a subset of these individuals displayed BAV aortopathy. NOTCH1 is expressed in multiple cell lineages that contribute to the aorta, and we found dysregulation of activated NOTCH1 expression in aneurysmal tissue from Marfan syndrome and BAV patients in comparison to control tissue. To investigate the role of NOTCH1 in AscAA, Notch1 haploinsufficiency was introduced into the Marfan syndrome mouse ( Fbn1 C1039G/+ ), a well-described model of AscAA. Serial echocardiographic, gross and histological characterization of the Notch1 deficient Marfan syndrome mice ( Notch1 +/- ;Fbn C1039G/+ ) demonstrated an exacerbated AscAA phenotype when compared to Fbn1 C1039G/+ mice. The compound mutant mice had increased aortic root diameter by three months of age (diameter: Notch1 +/- ;Fbn C1039G/+ = 2.11±0.11mm and Fbn1 C1039G/+ = 1.86±0.05mm, p&lt;0.05) as well as a higher rate of dilation from 1-5 months of age (rate: Notch1 +/- ;Fbn C1039G/+ =0.24±0.06mm/month and Fbn1 C1039G/+ =0.09±0.03mm/month, p&lt;0.05). Notch1 +/- and wildtype littermate mice had normal aortic diameters. Furthermore, a small subset (4/66) of the compound mutant mice succumbed to ascending aortic rupture, which was not observed in the Fbn1 C1039G/+ mice (0/63). Although endothelial Notch1 is critical for cardiovascular development, mice with heterozygous loss of Notch1 in endothelial cells that harbor the Fbn1 C1039G mutation ( Notch1 flox/+ ;Tie2-Cre +/- ;Fbn1 C1039G/+ ) did not recapitulate the phenotype of the Notch1 +/- ;Fbn C1039G/+ mice. Surprisingly, the phenotype was recapitulated with heterozygous loss of Notch1 in the lineage of secondary heart field cells ( Notch1 flox/+ ;Mef2C-AHF-Cre +/- ;Fbn1 C1039G/+ ) but not smooth muscle myosin heavy chain-expressing cells ( Notch1 flox/+ ;Myh11-Cre +/- ;Fbn1 C1039G/+ ). Our findings support a novel role for Notch1 in the non-endothelial secondary heart field and suggest that this loss of Notch1 alters a developmental process that contributes to AscAA.

Calcified Ascending Aortic Aneurysm

Calcified Ascending Aortic Aneurysm

Syphilitic aortic aneurysm in a young hepatitis B-infected man: Case presentation

Syphilitic aortit is a common manifestation of syphilis, involving the thoracic aorta, where destruction of elastic tissue in the media results in dilation and aneurysm formation. We report and identified a case of a 38-year old patient who presents a large ascending aorta aneurysm. He continues to carry the hepatitis B virus. The CT angiogram confirmed the presence of a giant fusiform ascending aortic aneurysm measuring 86mm of maximum diameter extending nearly to the origin of the brachiocephalic artery with normal diameter across the descending thoracic and abdominal aorta and no flow-limiting obstruction or significant atherosclerotic disease of the supra-aortic arteries. The definitive treatment of aortic aneurysm is surgical repair. Surgery and specific antibiotic treatment do not exclude future manifestations of the disease, even after erradication of the T. pallidum, which makes permanent follow-up needed.

Effects of statin therapy on ascending aorta aneurysms growth: A propensity-matched analysis

BackgroundPleiotropic effects of statins have been advocated for remodeling of the vascular wall. The aim of the present study was to investigate whether statin therapy influences the growth rate of ascending aorta (AA) diameter. MethodsA total of 1348 patients was referred to our outpatient clinic for initial AA ectasia from September 2005 to December 2011. A propensity score was built to perfectly match (1:1) patients administered (Group A) or not (Group B) with statin therapy. Clinical and echocardiographic follow-up was 100% completed at 3years after the first visit. Treatment groups were investigated for differences in AA maximum diameter, furthermore rates of survival free from death and/or complications were assessed by Kaplan–Meier analysis. ResultsFinally, two fairly-comparable groups of 329 patients each were obtained (Propensity model c-statistic 0.86, p<0.0001). At baseline, mean AA diameters were 38.88±2.48mm and 39.09±2.60mm in Groups A and B, respectively. At 3-years, similar rates of hypertension control (86±12% vs. 85±14%) were found, whilst growth rate of AA diameter was +2.84±1.33mm (or +0.95mm/year) in Group A and +3.80±1.69mm (or +1.27mm/year) in Group B (p<0.0001). Three-year survival free from the composite outcome (death, dissection/rupture, need for operative repair) was found to be significantly improved in Group A (85.4±2.0%) rather than in Group B (79.7±2.2%), with a log-rank p=0.05 (HR 0.69, 95% CI 0.47 to 1.01). ConclusionsIn this study, statin treatment is associated with reduced growth rate of ascending aorta aneurysms. The latter resulted in improved survival free from complications for patients receiving statins.

Abstract 679: Modeling Thoracic Aortic Aneurysm of Bicuspid Aortic Valve Patients with Induced Pluripotent Stem Cells Reveals Distinct Phenotypes of Smooth Muscle Cells from Different LIneages

Ascending aortic aneurysm occurs in 35%-68% patients with bicuspid aortic valves (BAV), which is more frequently than it does in patients with normal trileaflet aortic valves (TAV). In contrast to recurrent aneurysms of the ascending aorta, descending aortic aneurysms is very rare in patients with BAV. Vascular Smooth Muscle Cells (SMCs) make up the media of the aortic walls, and their contractile properties help sustain vessel tone. Interestingly, ascending aorta is populated by SMCs arising from neural crest and descending aorta by SMCs from paraxial mesoderm. An intriguing hypothesis is that the distinct susceptibility of aneurysm in the ascending and descending aorta in patients with BAV is due in part to disparities in SMC embryonic origins. To prove our hypothesis, we used an induced Pluripotent Stem Cells (iPS) model system to generate SMCs from neural crest and paraxial mesoderm. Firstly, iPSCs were established from a patient with BAV and ascending thoracic aortic aneurysm (BAV/TAA) and two control patients with normal aorta and TAV. The iPSCs pluripotency was verified by standard stem cell markers and teratoma formation. Neural crest stem cells (NCSCs) were differentiated from iPSCs and expressed neural crest markers, including P75, HNK1, AP2 and Sox9. In parallel, paraxial mesoderm cells (PMCs) were differentiated from iPSCs and expressed specific markers, including TCF15, TBX6, Meox1 and Pax1. The SMCs differentiated from both lineages had expression of SMC markers including MYH11, CNN1, ACTA2, SM22α. Interestingly, SMCs derived from BAV-NCSCs had significantly decreased in MYH11 and ACTA2 gene expression and impaired contractile property by gel contraction assay compared to SMCs derived from control-NCSCs. However, SMCs from BAV-PMCs had similar level of expression of MYH11 and ACTA2, and strong contractile activity with Carbacol treatment compared to SMCs derived from control PMCs. In conclusion, the iPS model system revealed decreased expression of contractile proteins and impairment of contractility in SMCs derived from NCSCs in BAV patient, but not in the SMCs derived from paraxial mesoderm cells. The high susceptibility of aneurysm in the ascending aorta in patients with BAV might be partly due to embryonic origin of the SMCs.

Diagnostic performance of focused cardiac ultrasound performed by emergency physicians for the assessment of ascending aorta dilation and aneurysm.

The diagnostic performance of transthoracic focused cardiac ultrasound (FoCUS) performed by emergency physicians (EP) to estimate ascending aorta dimensions in the acute setting has not been prospectively studied. The diagnostic accuracy and the interobserver variability of EP-performed FoCUS were investigated to estimate thoracic aortic dilation and aneurysm compared with the results of computed tomography angiography (CTA). This was a prospective single-center cohort study of a convenience sample of patients who underwent CTA in the emergency department for suspected aortic pathology. FoCUS was performed before CTA, and the maximum ascending aorta diameter evaluated in parasternal long-axis view. Aorta diameter <40mm by visual estimation or by diameter measurement was considered normal. Measurements were recorded in all patients with aorta diameter ≥40mm. Diagnostic accuracy of FoCUS for detection of aortic dilation (diameter ≥ 40mm) and aneurysm (diameter ≥ 45mm) were calculated considering the CTA result as reference standard. In a subgroup of patients, a second EP-sonographer performed FoCUS to evaluate interobserver agreement for the diagnosis of ascending aorta dilation. A total of 140 patients were enrolled in the study. Ascending aorta dilation and aneurysm were detected with FoCUS in 50 (35.7%) and in 27 (17.8%) patients, respectively. Sensitivity and specificity of FoCUS were 78.6% (95% confidence interval [CI]=65.6% to 88.4%) and 92.9% (95% CI=85.1% to 97.3%), respectively, for ascending aorta dilation and 64.7% (95% CI=46.5% to 80.2%) and 95.3% (95% CI=89.3% to 98.4%), respectively, for ascending aorta aneurysm. Interobserver agreement of FoCUS was k=0.82. FoCUS performed by EP is specific for ascending aorta dilation and aneurysm when compared to CTA and appears a reproducible technique.

The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy

BackgroundAortic stenosis may be related to coronary atherosclerosis in patients with tricuspid aortic valve, while aortic dilatation often is present in patients with bicuspid aortic valve. We sought to define associations among aortic stenosis, coronary atherosclerosis, and thoracic aortic aneurysm in patients with tricuspid or bicuspid aortic valve undergoing surgery for aortic stenosis in a large referral medical center. MethodsTwo hundred seventy patients with severe aortic stenosis (tricuspid 175, bicuspid 95) undergoing surgical aortic valve replacement (AVR) were studied. ResultsCoronary artery bypass grafting (CABG) surgery plus AVR was required more often in tricuspid compared to bicuspid aortic valve [62.2% versus 26.3%; p<0.0001; odds ratio 4.5, confidence interval (CI) 2.5–8.3]. The incidence of coronary atherosclerosis requiring CABG in bicuspid aortic valve (26.3%) was greater than that expected in the general population for similar age. Thoracic aorta surgery due to aortic aneurysm plus AVR was performed more often in bicuspid compared to tricuspid aortic valve (27.3% versus 3.4%; p<0.0001; odds ratio 7.7, CI 3.0–22.1). The incidence of ascending aorta aneurysm requiring surgery, however, was not more common in tricuspid aortic valve (3.4%) to that expected in the general population for similar age. ConclusionIncidence of coronary atherosclerosis is high in patients with aortic stenosis, both in those with tricuspid and bicuspid aortic valve. Incidence of ascending aortic aneurysm is high in patients with bicuspid, but not those with tricuspid aortic valve. These findings should be taken into consideration in the evaluation and management of patients with the aortic stenosis complex.

Patient-specific finite element analysis of ascending aorta aneurysms.

Catastrophic ascending aorta aneurysm (AsAA) dissection and rupture can be prevented by elective surgical repair, but identifying individuals at risk remains a challenge. Typically the decision to operate is based primarily on the overall aneurysm size, which may not be a reliable indicator of risk. In this study, AsAA inflation and rupture was simulated in 27 patient-specific finite element models constructed from clinical CT imaging data and tissue mechanical testing data from matching patients. These patients included n = 8 with concomitant bicuspid aortic valve (BAV), n = 10 with bovine aortic arch (BAA), and n = 10 with neither BAV nor BAA. AsAA rupture risk was found to increase with elevated systolic wall stress and tissue stiffness. The aortic size index was sufficient for identifying the patients with the lowest risk of rupture, but unsuitable for delineating between patients at moderate and high risk. There was no correlation between BAV or BAA and AsAA rupture risk; however, the AsAA morphology was different among these patients. These results support the use of mechanical parameters such as vessel wall stress and tissue stiffness for AsAA presurgical evaluation.