Layers Of Aortic Wall Research Articles

Predicting false lumen thrombosis in patient-specific models of aortic dissection.

Aortic dissection causes splitting of the aortic wall layers, allowing blood to enter a ‘false lumen’ (FL). For type B dissection, a significant predictor of patient outcomes is patency or thrombosis of the FL. Yet, no methods are currently available to assess the chances of FL thrombosis. In this study, we present a new computational model that is capable of predicting thrombus formation, growth and its effects on blood flow under physiological conditions. Predictions of thrombus formation and growth are based on fluid shear rate, residence time and platelet distribution, which are evaluated through convection–diffusion–reaction transport equations. The model is applied to a patient-specific type B dissection for which multiple follow-up scans are available. The predicted thrombus formation and growth patterns are in good qualitative agreement with clinical data, demonstrating the potential applicability of the model in predicting FL thrombosis for individual patients. Our results show that the extent and location of thrombosis are strongly influenced by aortic dissection geometry that may change over time. The high computational efficiency of our model makes it feasible for clinical applications. By predicting which aortic dissection patient is more likely to develop FL thrombosis, the model has great potential to be used as part of a clinical decision-making tool to assess the need for early endovascular intervention for individual dissection patients.

Aortic dissection: medical, interventional and surgical management

### Learning objectives After reading this article, the readers should be able to: Acute aortic dissection (AAD) is a relatively rare but much-feared clinical presentation which has a high mortality,...

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case-control study.

To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

MULTIDETECTOR COMPUTED TOMOGRAPHY FOR IDENTIFICATION OF INSTABILITY OF AORTIC ANEURYSM WALL

Актуальность. Аневризма аорты – распространенное заболевание с полиморфной клинической картиной и внезапным риском развития тяжелых осложнений.

The 14q32 MicroRNA-487b Targets the Antiapoptotic Insulin Receptor Substrate 1 in Hypertension-Induced Remodeling of the Aorta

To study the role of microRNAs in hypertension-induced vascular pathology before the onset of symptoms of severe cardiovascular disease. MicroRNAs play a crucial role in cardiovascular disease. However, microRNAs are often studied in full-blown cardiovascular disease models, not during development of cardiovascular pathology. Angiotensin II was infused into healthy adult rats, inducing chronic hypertension, and microRNA expression profiles were obtained. The most prominently regulated microRNA, miR-487b, was further investigated, using primary cultures of rat aortic and human umbilical cord arterial cells. MiR-487b is predicted to target insulin receptor substrate 1 (IRS1). IRS1 plays an important role in both insulin signaling and cell proliferation and survival. IRS1 mRNA and protein levels were downregulated in aortae of hypertensive rats. MiR-487b binds directly to both rat and human IRS1 3'UTR and inhibits reporter gene expression in vitro. In primary rat and human arterial adventitial fibroblasts, inhibition of miR-487b leads to upregulation of IRS1 expression. Upregulation of miR-487b had the opposite effect, confirming direct targeting of IRS1 by miR-487b.Immunohistochemistry of aortic cross sections and rt/qPCR analyses of the separate aortic wall layers showed that both IRS1 and miR-487b were present mainly in the adventitia and less or not at all in the intima and tunica media. IRS1 expression in adventitial fibroblasts was predominantly nuclear and nuclear IRS1 is known to have antiapoptotic effects. Indeed, inhibition of miR-487b protected adventitial fibroblasts, and also medial smooth muscle cells, against serum starvation-induced apoptosis and increased cell survival. Angiotensin II-induced hypertension leads to upregulation of miR-487b, which targets IRS1. Via downregulation of IRS1, miR-487b can contribute to cell death and loss of adventitial and medial integrity during hypertension-induced vascular pathology.

Part One: For the Motion. Level 1 Evidence is Necessary Comparing TEVAR and Medical Management of Uncomplicated Type B Aortic Dissection

Part One: For the Motion. Level 1 Evidence is Necessary Comparing TEVAR and Medical Management of Uncomplicated Type B Aortic Dissection

Type A Dissection After Implantation of a Stent-Graft Triggered by an Intramural Hematoma

To describe an unusual case of multiple aneurysm disease in a patient who developed stent-graft-associated type A dissection. A 72-year-old man presented with pericardial tamponade, which was treated with pericardial drainage. A small intramural hematoma of the ascending aorta was found originating from a proximal descending thoracic aortic aneurysm (TAA); he also had an infrarenal abdominal aortic aneurysm (AAA). After stabilization of the hematoma 7 weeks later, the TAA was repaired with a Relay stent-graft. Type A dissection followed after 3 days and acute rupture of the AAA 6 days later. Emergency surgical repair of both complications achieved successful outcome of an extended 3-stage procedure. This case provides insight into the mechanisms that may contribute to stent-graft-associated type A dissection. Probably the previous separation of the aortic wall layers by the intramural hematoma triggered the complication, although the aorta appeared to have stabilized.

Regional and directional variations in the mechanical properties of ascending thoracic aortic aneurysms

This study aimed to assess regional and directional differences in the mechanical properties of ascending thoracic aortic aneurysms (ATAA). Whole fresh ATAA were taken from twelve patients, undergoing elective surgical repair, and cut into tissue specimens. These were divided into groups according to direction and region, and subjected to uniaxial testing beyond rupture. In the majority of tests, the inner layers of the aortic wall ruptured first; failure stress (measure of tissue strength) and peak elastic modulus (measure of tissue stiffness) were significantly higher circumferentially in all regions. Marked heterogeneity was evident in the mechanical properties of ATAA, with the anterior region longitudinally being the weakest and least stiff of all regions. No correlation was found between failure stress and ATAA diameter or patient age. Failure stress showed inverse correlations with wall thickness and direct correlations with peak elastic modulus. The current information, relating to regional and directional differences, may provide a better understanding of the mechanism responsible for the development of circumferential tears of the inner aortic wall layers in ATAA dissections.

Endovascular treatment of painless aortic ulcer detected by transesophageal echocardiography as an incidental finding

Penetrating aortic ulcer (PAU) is defined as an ulcerating atherosclerotic lesion that disrupts the aortic wall layers, penetrating the internal elastic lamina. The natural history of the disease and the preferred treatment are still debated. We report a case of painless PAU in a 78-year-old man detected by transesophageal echocardiography at the level of proximal descending aorta as an incidental finding. The patient underwent endovascular stent-graft placement without any complications at early and late follow-up.

Platelet-derived growth factor B retention is essential for development of normal structure and function of conduit vessels and capillaries☆

Extracellular retention of PDGF-B has been proposed to play an important role in PDGF-B signalling. We used the PDGF-B retention motif knockout mouse (RetKO) to study the effects of retention motif deletion on development of micro- and macrovascular structure and function. Passive and active properties of conduit vessels were studied using myograph techniques and histological examination. Capillary structure and function was studied using measurements of capillary density in skeletal muscle and by assessing aerobic physical performance in a treadmill setup. Cardiac function was assessed using echocardiography. Myograph experiments revealed an increased diameter and stiffness of the aorta in RetKO. Histological examination showed increased media collagen content and a decreased number of aortic wall layers, however with a similar number of vascular smooth muscle cells. This outward eutrophic remodelling of the aorta was accompanied by endothelial dysfunction. RetKO showed decreased capillary density in skeletal muscle and signs of a defective delivery of capillary oxygen to skeletal muscle, as shown by a decreased physical performance. In RetKO mice, echocardiography revealed an adaptive eccentric cardiac hypertrophy. We conclude that retention of PDGF-B during development is essential for a normal conduit vessel function in the adult mouse. Furthermore, PDGF-B retention is also necessary for the development of an adequate capillary density, and thereby for a normal oxygen delivery to skeletal muscle. The lack of primary effects on cardiac function supports the redundant role of PDGF-B in cardiac development.

Aortic lesions in aspergillosis: histopathological study of two autopsy cases

The involvement of the aorta in aspergillosis is relatively rare, and its histopathological features have not been described in detail. In two autopsy cases of invasive aspergillosis in immunologically compromised patients with hematological disorders, the aspergillotic lesions of the aorta showed different characteristic histopathological features depending on the three layers of aortic wall. Intimal lesions were formations of the mural thrombus composed of aggregates of numerous fungal hyphae arranged perpendicularly to the aortic wall. In the media, smooth muscle cells were completely necrotic (anemic infarct of the media), while the framework of elastic fibers was well preserved, with only a few fungal hyphae detected. In the adventitia, an intense, partly granulomatous chronic inflammatory change with fibrosis was observed in association with mycotic embolic occlusion of the vasa vasorum. These histopathological changes were considered to represent one of the typical tissue reaction patterns in the wall of an elastic artery in aspergillosis.

Finite element model determination of correction factors used for measurement of aortic diameter via conductance.

Traditional methods for estimating the slope alpha and offset volume Vp for determining real-time chamber volume by the conductance catheter technique are not suited to measurements made in the aorta due to the relatively low resistivity of the aortic wall. We developed three distinct three-dimensional finite element models of the conductance catheter and surrounding tissues in order to predict alpha and Vp and to examine the nature of the electric field near the aortic wall. A heterogeneous isotropic model of the catheter, aorta and surrounding tissues accurately predicted the values of alpha and Vp. A homogeneous anisotropic model was developed to examine the effects of anisotropy of blood and the layers of the aortic wall on measured values of resistance, alpha and Vp. This model demonstrated that anisotropy of blood and aortic wall tissue can increase the values of both alpha and Vp. Finally, a three-dimensional homogeneous isotropic rectangular model allowed examination of the effects of catheter position. This model showed small effects of catheter position on measured resistance (9.7% increase) and larger effects on alpha (21.2% decrease) and Vp (41.9% increase). We conclude the following: the FEA models may lead to accurate estimate values of alpha and Vp in vivo. The unique anisotropic conductive properties of the layers of the aortic wall contribute to the high observed values of alpha and Vp in the aorta. Finally, catheter position has a proportionately greater effect on alpha and Vp than on measured resistance. The results of this study should assist in the determination of aortic mechanical properties using conductance catheter measurements of vessel dimension.

New-generation valved conduit: An experimental study

Objective: An ideal valved conduit to repair complex congenital heart defects is yet to be developed. In this study we have evaluated the merits of our newly developed calcification-free biologic valve incorporated in a compatible conduit of biologic origin in an animal model. Methods: Porcine aortic valves and main pulmonary arteries were cross-linked in glutaraldehyde, followed by coupling to partially degraded heparin through an intermediate surface-bound substrate containing amino groups. Because commercially available valves are treated only with glutaraldehyde, control aortic valves and main pulmonary arteries were cross-linked in 0.625% glutaraldehyde. Valved conduits were fabricated from main pulmonary arteries, which were sewn to the aortic and ventricular ends of aortic valves. Valved conduits were examined for calcification and other pathologic changes after being implanted in the descending thoracic aorta in juvenile sheep for 5 months. Results: Severe calcification was noticed in all layers of cusps (calcium, 231.86 ± 17.90 mg/gm) and aortic wall (calcium, 123.24 ± 24.72 mg/gm) of aortic valves and main pulmonary arteries (calcium, 135.43 ± 26.63 mg/gm) of valved conduits treated with 0.625% glutaraldehyde. Cusps (calcium, 1.28 ± 0.22 mg/gm) of the aortic valve of heparin-bonded conduits did not calcify at all. Only sparse calcific deposits were noticed in the medial layer of the aortic wall (calcium, 25.90 ± 22.79 mg/gm) of aortic valves and main pulmonary arteries (calcium, 9.64 ± 10.79 mg/gm) of the valved conduits coupled to heparin. Conclusion: Heparin coupling is effective in preventing calcification of glutaraldehyde cross-linked valved conduits implanted in the systemic circulation of juvenile sheep. J Thorac Cardiovasc Surg 1997;114:218-23

Selective isolation of rat aortic wall layers and their cell types in culture—Application to converting enzyme activity measurement

The rat aorta, whose three wall layers can be separated by microdissection offers the rare possibility of comparing physiological characteristics of in vivo tissular cell components and corresponding cells after culture. We developed a technique allowing the dissociation of the three tunicae (intima, media and adventitia) of the rat aorta and the culture of their main cell types i.e: endothelial cells (EC) from intima, smooth muscle cells (SMC) from media and fibroblasts (Fib) from adventitia. Comparison between selected tunicae in vivo and their corresponding cells in vitro was performed via arterial angiotensin converting enzyme (ACE) activity measurements in Wistar rats. In vivo microsomial ACE activity for each tunica was as follows: 368.9 ± 34.3 (endothelium), 10.5 ± 1.9 (media) and 10.2 ± 4.9 (adventitia) pmol/mg protein/min. Corresponding cell primary culture values were 1.2 ± 0.1 (EC), 0.06 ± 0.02 (SMC) and 0.24 ± 0.01 (Fib) pmol/mg protein/min. Incubation of serum-deprived cells with Dexamethasone (10 −7M) over 48 hr induced a statistically significant shift of total ACE activity from controls to stimulated cells of 2.9 ± 0.3 to 9.7 ± 1.0 in EC, 0.8 ± 0.1 to 32.1 ± 4.9 in SMC and 1.03 ± 0.65 to 57.2 ± 2.1 pmol/ mg prot/min in fibroblasts. In the rat aorta, ACE was present not only in the intimal endothelial cell lining, but also in the media and the adventitia. ACE activity levels in primary cultured vascular cells were about 100-fold less than those found in the ex vivo tissues. Nevertheless, ACE expression seems to be more constitutive in endothelial cells and more inducible in smooth muscle cells and fibroblasts. This methodological approach should be of interest in studying environmental or genetic regulation of protein expression in the three layers/three cell types of the vascular wall.

Characterization of a polyepoxy compound fixed porcine heart valve bioprosthesis.

Concerns with the currently available bioprostheses are calcification, long-term durability, and suboptimal hemodynamic performance. It is well known that these concerns are all more or less related to the cross-linking reagent, glutaraldehyde or formaldehyde, used in fixing bioprostheses. To address these concerns, we undertook the development of a porcine bioprosthesis fixed with a polyepoxy compound. In the development of this polyepoxy compound valve, it was found that the porcine leaflets fixed with polyepoxy compound were softer and more pliable than those fixed with glutaraldehyde. In this study, a special microtoming technique was developed to section the biological tissue so that the fixation uniformity in distinct layers of porcine aortic wall could be characterized. The fixation index and the denaturation temperature measurements in distinct layers of aortic walls showed that the cross-linking density was uniform throughout the entire aortic wall for the polyepoxy compound fixed porcine valve. It was also noted that the fixation index of the polyepoxy compound fixed aortic wall (91.5 +/- 0.5, n = 3) was not significantly different from that of its valvular leaflet (90.6 +/- 0.8, n = 3). Similarly, the denaturation temperature of the polyepoxy compound fixed aortic wall (80.4 +/- 0.9 degrees C, n = 5) was statistically comparable to that of its valvular leaflet (79.0 +/- 0.5 degrees C, n = 5). The results of this study indicated that polyepoxy compound can adequately fix the entire porcine aortic wall as well as its valvular leaflets.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficient tissue gluing in aortic dissection.

The authors' method for uniting the dissected aortic wall layers with the help of gelatine-resorcinol adhesive is described focusing on special instruments used in this conjunction.

Comparison of the Cross-linking Characteristics of Porcine Heart Valves Fixed with Glutaraldehyde or Epoxy Compounds

The concerns about currently available bioprosthetic heart valves are calcification, long-term durability, and functional and hemodynamic performance. These concerns are all more or less related to the cross-linking reagents, glutaraldehyde or formaldehyde, used in fixing bioprostheses. To address these concerns, the authors undertook the development of a porcine heart valve cross-linked with an epoxy compound. This study compared the cross-linking characteristics, shrink temperature, and moisture content of porcine heart valves fixed with epoxy compounds or glutaraldehyde. Two types of epoxy compounds, Denacol EX-313 and EX-810, or a 0.625% glutaraldehyde were used to fix the porcine aortic valves procured from a slaughter house. Samples of each group were removed at various elapsed fixation times. The shrink temperature and moisture content of the valvular leaflet and distinct layers of aortic wall of each sample were measured. Fresh porcine aortic valve was used as a control. It was found that the shrink temperature of the glutaraldehyde leaflet was the highest, whereas the moisture content of the EX-313 leaflet was the greatest among the three test groups. No significant difference in shrink temperature was observed among the epoxy compound fixed inner, middle, outer, and entire aortic walls. This implied that the cross-linking density of the epoxy compound valve was uniform throughout the entire aortic wall. The same also was observed for the glutaraldehyde fixed aortic wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Dissociated cells from different layers of adult human aortic wall.

Cells isolated from a fixed adult human aorta by alcoholic-alkaline dissociation retain their intrinsic shape. They are represented by four major morphological types: stellate, elongated, elongated with side processes, and irregularly shaped cells. All the four types of cells were found in the elastic-hyperplastic intimal sublayer ; elongated and irregularly shaped cells were mainly observed in the musculoelastic sublayer and in the media. Cell density in the atherosclerotic lesion is higher than normal, the number of stellate cells being increased more substantially compared to other cell types. The origin of stellate cells and other morphological cell types, and reasons for their disproportionate accumulation in the atherosclerotic intima are discussed.

Permeability of inner and outer layers of rat and rabbit aortic wall: Two new microscopic test with trypan blue

Two new permeability tests are described for use with intravenously injected trypan blue. One depends on the demonstration of trypan blue by its specific red fluorescence in green light at 570 nm, while the other is a surface microscopy technique at low magnification, using illumination from a fibre-optics light source. The routes of entry of the trypan blue-albumin complex into the rat and rabbit aorta appear to be from both the inner and outer surfaces. Over the period 1 4 –24 h after injection of the dye, more entered from the outer surface than the inner surface in the rat aorta and rather more in the rabbit thoracic aorta. The arch of the rabbit aorta showed in general rather greater entry from the inner surface. Trypan blue that has entered the aortic wall is partly taken up by the elastic lamellae. Elastic competes successfully for the dye and captures it from the trypan blue-albumin complex; this uptake is blocked by deamination with nitrous acid.

A comparison of free amino acids in the plasma and in the aortic wall

The distribution of the different free amino acids in plasma and in two aortic wall layers are compared. The following findings are presented: There is a higher concentration of free amino acids in the arterial wall than in the plasma. For the major part of the essential amino acids, one finds 1.5 to 3 times more in the aortic wall. For some others, especially for the amino acids synthetized by the Krebs pathway, the difference is much more important. Several amino acids present in the aortic wall could not be detected in the plasma. These findings suggest an active transport of amino acids against a concentration gradient and the synthesis of some other amino acids in situ.