Thoracic Aorta In Patients Research Articles

Frozen Elephant Trunk Procedure for Acute Type a Aortic Dissection: Analysis of Distal Aortic Remodeling According to the Society for Vascular Surgery (SVS)/Society of Thoracic Surgeons (STS) Reporting Standard

ObjectiveTo investigate impact of Frozen Elephant Trunk (FET) on long-term distal aortic remodelling in acute AAD according to the latest recommended standards from the Society for Vascular Surgery (SVS)/Society of Thoracic Surgeons (STS). MethodsClinical data and imaging of patients undergone FET to treat acute AAD over the last 8 years were retrospectively reviewed. Patients were included if a pre- and post-operative Computed AngioTomographies at least 30-day from surgery was available for comparison. Contrasted postprocessed imaging were analysed with Aquarius iNtuition (TeraRecon Inc., Foster City, CA, USA) to analyse long-term positive aortic remodelling, FL thrombosis and aortic expansion according to the SVS/STS recommendations. Secondary endpoints were the rate of in-hospital and long-term mortality, spinal cord ischaemia and aortic-related reinterventions. ResultsOut of 75 patients who underwent FET for type A AAD, n=41(54.6%) were included. Significant positive aortic remodelling was reported in Ishimaru zone 1-4 but not in visceral/infrarenal aorta (p<0.001) and overall rate of FL thrombosis was 95.1% (n=39). Aortic expansion rates were: 4.9% in zones 1-4, 8.3% in zones 5-6 and 15% in zone 7. The rates of in-hospital mortality and long-term mortality were 7.3% (n=3) and 9.7% (n=4) respectively. At a median follow-up of 11 months (range 1-141, reintervention rate was 17.1%. ConclusionsWe report positive aortic remodelling of the distal thoracic aorta in patients who underwent FET for acute AAD according to the SVS/STS reporting standards. The positive effect on the distal aorta is limited to the thoracic segments but not in the visceral aorta.

Spinal cord ischemia during endovascular repair of the thoracic aorta

Background and objectives: This work aims to analyze the incidence of medullary ischemia (MI) and identify the factors contributing to its development during endovascular repair of the descending thoracic aorta in patients requiring complete coverage. Material and methods: A retrospective study. Between April 1999 and December 2014, 176 thoracic aortic endovascular repairs were performed. Sixty-two patients (48 male and 14 female) were treated with thoracic stents from the aortic arch to the celiac trunk due to thoracoabdominal aneurysms (n = 13), aortic dissections (n = 42), intramural hematomas (n = 4), post-traumatic pseudoaneurysms (n = 2) and aortic ulcers (n = 1). All procedures were performed under general anesthesia with strict invasive blood pressure control. Cerebrospinal fluid drainage was performed in 5 patients. Results: The success rate of stent placement was 96.7%, and mortality was 4.84%. The incidence of spinal cord ischemia was 4.84% (3 patients, one in the immediate postoperative period and two during follow-up). Permanent paraplegia was observed in 1.6%. Overall survival (Kaplan-Meier) at 1, 3, and 6 years was 76%, 69.1%, and 64.32%, respectively. Conclusions: thoracic aortic coverage is an effective procedure with a high probability of success. Our study identified a previous procedure on the abdominal aorta and a thromboembolic aortic event as risk factors for developing medullary ischemia in patients requiring complete coverage of the thoracic aorta. In this study, full coverage of the thoracic aorta and left subclavian artery alone are not predictors of paraplegia.

Elastic properties of aorta with respect to its dilatation vs aneurysm according to ECG-synchronized CT-angiography

Purpose: to compare the indicators of elasticity of the thoracic aorta, determined by ECG-Gated-CT angiography, in patients with ascending aortic aneurysm and dilatation.Materials and methods. The study included 20 patients with dilatation of the ascending aorta (40 mm ≤ maximum aortic diameter (Dmax) &lt; 50 mm) (group 1a), 30 patients with non-syndromic aneurysms of the ascending aorta (n = 30, Dmax ≥ 50 mm) (group 1b), as well as 19 patients with normal aortic sizes (Dmax &lt; 40 mm) as controls (group 2). All patients underwent multispiral computed tomography angiography of the aorta in ECG-Gated mode (ECG-Gated -CT). Maximum systolic and diastolic aortic diameters (Dmax) were measured at different levels of the thoracic aorta, followed by calculation of the difference between them and calculation of the circular deformation (CS), compliance, stiffness (Stiff), wall distensibility, longitudinal deformation (LS).Results. Moderate negative correlation between the age of the patients and CS at all levels of the thoracic aorta (rmaximum = –0.33, rminimum = –0.41) was revealed. Groups 1a and 1b did not differ significantly in all parameters. Group 1a differed from the control group (p &lt; 0.05) in Stiff at the level of the aortic annulus (AA) (0.07 [–0.14; 0.15] vs –0.04 [–0.1; 0.06]), as well as CS at the level of AA and sinuses of Valsalva (SV ) (0.49 [–2.94; 3.36] vs –1.18 [–4.51; 3.87]), and group 1b – in CS at the level of SV (3.73 [0.24; 6.56] vs 0.13 [–1.42; 3.04]) and proximal part of the descending aorta (distal to the left subclavian artery) (5.48 [1.27; 8.40] vs 1.97 [–0.32; 6.08]), also in LS (5.96 [–8.98; 9.25] vs –2.58 [–7.75; 1.89]) at the level of the aortic arch.Conclusion. According to ECG-Gated-CT angiography, the indicators of elasticity of the thoracic aorta in patients with ascending aortic aneurysm and dilatation did not differ. Compared with the control group, patients with aneurysm of the ascending aorta showed an increased pulse deformity of the non-dilated aortic arch.

Activity of matrix metalloproteinase type 9 and its relationship with calcification of the thoracic aorta in patients with resistant hypertension: cross-sectional comparative study

Background. The extracellular matrix of vessels is degraded under the influence of matrix metalloproteinases (MMPs). MMP type 9 is of particular interest in arterial hypertension (AH) since its activity is regulated by a tissue inhibitor of matrix metalloproteinase type 1 (TIMP1). The balance of their ratio can shift in either direction depending on the disease stage and provoke vascular wall calcification.&#x0D; Objective. This cross-sectional comparative study investigated the level of MMP9 and its type 1 tissue inhibitor and their relationship with the severity of thoracic aorta calcification in patients with resistant hypertension, depending on antihypertensive therapy effectiveness.&#x0D; Material and methods. The study included 92 patients with resistant hypertension. All patients underwent 24-hour blood (BP) pressure monitoring (ABPM), and had their index of the thoracic aorta (ТАС) and the plasma levels of MMP9 and TIMP1 assessed.&#x0D; Results. Patients were divided into groups based on whether they achieved the BP target level according to the results of ABPM: controlled (n=44) and uncontrolled (n=48) resistant AH. In the second group, most estimated parameters of ABPM were higher, and the variants of the daily BP profile for non-dipper and night-peaker systolic blood pressure (SBP) were more common than in the first group. In the second group, a more pronounced increase in TAC, TIMP1, and TIMP1/MMP9 levels was revealed. Evaluation of the relationship between the studied parameters revealed a positive relationship between TAC and age (r=0.683, p 0.00001), hypertension duration (r=0.610, p 0.00001) and a negative relationship with regular antihypertensive therapy duration (r=0.822, p 0.00001). ТАC was higher in individuals with higher values of SBP (r=0.513, р 0.00001), pulse BP (r=0.805, р 0.00001), rate of morning rise in BP (r=0.678, р 0.00001) and insufficient decrease in SBP at night (r=-0.822, р 0.00001). There was a positive correlation of moderate strength TAC with the level of low-density lipoproteins (r=0.490, p=0.0002), TIMP1 (r=0.344, p=0.005) and the TIMP1/MMP9 ratio (r=0.481, p 0.00001).&#x0D; Conclusion. In patients with resistant hypertension, an increase in the TAC was revealed, which has a statistically significant direct correlation with the value of pulse BP, the morning rise in BP, and an insufficient decrease in SBP at night. An imbalance in the TIMP1/MMP9 ratio, rather than an isolated increase in MMP9, can indicate the intensity of the formation and degradation of the extracellular matrix components in patients with resistant AH, which triggers the vascular wall calcification process.

Aorta and tracheobronchial invasion in esophageal cancer: comparing diagnostic performance of 3.0-T MRI and CT.

To compare between the diagnostic performance of 3.0-T MRI and CT for aorta and tracheobronchial invasion in patients with esophageal cancer (EC). We prospectively included patients with pathologically confirmed EC from November 2018 to June 2021, who had baseline stage of T3-4N0-2M0 and restaging after neoadjuvant chemotherapy. All patients underwent contrast-enhanced CT and MRI of the thorax. Two independent blinded radiologists scored image quality and the presence of invasion. Agreements between the two readers were calculated using kappa test. The sensitivity, specificity, accuracy, positive predict value (PPV), and negative predict value (NPV) of MRI and CT in evaluating invasion were calculated. The net reclassification index (NRI) was used to evaluate the change in the number of patients correctly classified by MRI and CT. A total of 70 patients (64.8 ± 9.0years; 53 men) were enrolled. Inter-reader agreements of image quality scores and presence of invasion by MRI and CT between the two readers were almost perfect (kappa > 0.80). The accuracy of MRI in evaluating thoracic aorta invasion was significantly higher than that of CT (reader 1: 90.0% vs. 71.4%; reader 2: 92.9% vs. 70.0%, respectively), and the accuracy of MRI in evaluating tracheobronchial invasion also was significantly higher than that of CT (reader 1: 92.9% vs. 72.9%; reader 2: 95.7% vs. 70.0%, respectively). NRI values were positive in both the evaluation of aorta and tracheobronchial invasion. The accuracy of 3-T MRI in determining thoracic aorta and tracheobronchial invasion is significantly higher than that of CT. • 3.0-T MRI was significantly more accurate than CT in assessing invasion of the thoracic aorta in patients with esophageal cancer. • 3.0-T MRI was also significantly more accurate than CT in assessing tracheobronchial invasion in patients with esophageal cancer. • 3.0-T MRI has a higher diagnostic performance than CT in evaluating patients with suspected aortic or tracheobronchial invasion in esophageal cancer.

Association of clinical and mechanical parameters of intraoperative samples of thoracic aorta in patients with aortic aneurysm

Association of clinical and mechanical parameters of intraoperative samples of thoracic aorta in patients with aortic aneurysm

Abstract #1319213: Turner Syndrome and Cardiovascular Anomalies

Turner syndrome (TS) results from complete or partial absence of the second sex chromosome in either all or part of the cells of an individual. It is the most common chromosomal abnormality affecting females. Early morbidity and mortality are increased in patients with TS compared with the general population and are related mainly to cardiovascular complications. Visualizing the descending thoracic aorta in patients with Turner syndrome with echocardiography is difficult. Therefore, cardiac MRI is the preferred imaging modality for surveillance.

Thoracic endovascular aneurysm repair in patients with connective tissue disorders

The contemporary data regarding the role of the thoracic endovascular aneurysm repair (TEVAR) in patients with connective tissue disorders (CTD) are reviewed. We performed search of the data in electronic databases PubMed, SCOPUS, Embase, Google Scholar OVID, related to the use of TEVAR. Currently, there is a limited amount of large cohort size studies outlining the use of TEVAR in patients with CTD. Endovascular prosthetics of the thoracic aorta in patients with accidents is dangerous because of the progressive dilatation of the aorta and the high probability of further re-interventions in later life. The analysis showed that open reconstruction still remains a gold standard of intervention in young patients with progressive CTDs, especially in acute type of aortic dissection. However, long-term data need to be published to support this practice.

Long-Term Clinical and Radiographic Outcomes in Patients With Clinically Isolated Aortitis.

The optimal management of patients with incidentally found clinically isolated aortitis (CIA) after aneurysm repair is unclear. This study compared long-term surgical and clinical outcomes after surgical repair of thoracic aortic aneurysm between patients with CIA and patients with noninflammatory etiologies. This is a matched cohort study. Patients with CIA were identified by histopathology following open thoracic aortic aneurysm repair. Two comparators without inflammation on pathology were matched to each patient by year of surgical repair. Outcomes included surgical complications, new vascular abnormalities on imaging, and death. One hundred sixty-two patients were included: 53 with CIA and 109 matched comparators. Median follow-up time was similar between groups (CIA 3.7 vs. comparator 3.3 years, P=0.64). There was no difference in postoperative complications, surgical revision, or death between groups. Only 32% of patients with CIA saw a rheumatologist in the outpatient setting and 33% received immunosuppressive treatment. On surveillance imaging, no difference was seen in new or worsening aortic aneurysms, but there were significantly more vascular abnormalities in branch arteries of the thoracic aorta in patients with CIA (39% vs. 11%, P < 0.01). Among patients who underwent surgical repair of a thoracic aortic aneurysm, patients with CIA were more likely than noninflammatory comparators to develop radiographic abnormalities in aortic branch arteries. Notably, there was no difference in risk of new aortic aneurysms or surgical complications despite most patients with CIA never receiving immunosuppression. This suggests that more selective initiation of immunosuppression in CIA may be considered after aortic aneurysm repair.

REATIVIDADE DA AORTA TORÁCICA EM PACIENTES OBESOS SUBMETIDOS AO EXERCÍCIO AERÓBICO

ABSTRACT Introduction: Aerobic exercise can improve the function of the cardiovascular circulatory system, reducing morbidity and mortality from cardiovascular disease by stimulating the production of endogenous self-protection. Activating potassium channels in vascular smooth muscle cells can cause vasodilation and increase blood flow, lowering blood pressure. There is a sensitivity to intracellular ATP and ADP concentration among the variety of potassium channels distributed in vascular smooth muscle cells, which vary mainly during aerobic physical activity. Objective: Explore the effect of aerobic exercise on the vascular reactivity of the thoracic aorta in patients with obesity and hyperlipidemia. Methods: Randomized controlled trial in twenty male Wistar rats weighing 250g and two months old. The control group remained at rest while the experimental group performed aerobic exercise on a treadmill at increasing speed for eight weeks. The rats were dissected, and dilatators and vasoconstrictors drugs stimulated their blood vessels in a tamponade solution. Observation of vascular changes was measured under controlled tensioning. Results: The blockade of KATP channels in vascular smooth muscle caused tonic contraction of vascular smooth muscle cells and increased blood pressure. Conclusion: Long-term regular aerobic exercise may induce changes in rats’ thoracic aortic vascular function and vascular smooth muscle reactivity. Aerobic exercise can also significantly improve the activity of KATP channels. Evidence Level II; Therapeutic Studies – Investigating the results.

A Pilot Study Characterizing Flow Patterns in the Thoracic Aorta of Patients With Connective Tissue Disease: Comparison to Age- and Gender-Matched Controls via Fluid Structure Interaction

Prior computational and imaging studies described changes in flow patterns for patients with Marfan syndrome, but studies are lacking for related populations. This pilot study addresses this void by characterizing wall shear stress (WSS) indices for patients with Loeys-Dietz and undifferentiated connective tissue diseases. Using aortic valve-based velocity profiles from magnetic resonance imaging as input to patient-specific fluid structure interaction (FSI) models, we determined local flow patterns throughout the aorta for four patients with various connective tissue diseases (Loeys-Dietz with the native aorta, connective tissue disease of unclear etiology with native aorta in female and male patients, and an untreated patient with Marfan syndrome, as well as twin patients with Marfan syndrome who underwent valve-sparing root replacement). FSI simulations used physiological boundary conditions and material properties to replicate available measurements. Time-averaged WSS (TAWSS) and oscillatory shear index (OSI) results are presented with localized comparison to age- and gender-matched control participants. Ascending aortic dimensions were greater in almost all patients with connective tissue diseases relative to their respective control. Differences in TAWSS and OSI were driven by local morphological differences and cardiac output. For example, the model for one twin had a more pronounced proximal descending aorta in the vicinity of the ductus ligamentum that impacted WSS indices relative to the other. We are optimistic that the results of this study can serve as a foundation for larger future studies on the connective tissue disorders presented in this article.

Clinical-instrumental correlations of local elastic properties of the thoracic aorta in patients with coronary atherosclerosis

Introduction . This is part of research with aim of increasing the effectiveness of echocardiography in patients with coronary atherosclerosis by assessing local elastic properties of the thoracic aorta using modern ultrasound technologies. Aim . To analyze correlations between deterioration of local elastic properties of the thoracic aorta, impairment of renal filtration function, severity of left ventricular hypertrophy and ischemic heart disease (IHD) risk factors in patients with coronary atherosclerosis. Materials and methods . From 2016 to 2019, 109 patients aged 39 to 82 years, who were divided into 2 groups according to the results of invasive coronarography, were examined: 64 patients with coronary atherosclerosis and 45 patients without coronary atherosclerosis. Using transthoracic echocardiography, the following were obtained: coefficient of distensibility, compliance coefficient, Peterson’s elasticity modulus, stiffness index of the ascending thoracic aorta. Analysis of correlations between these indices, indicators of IHD risk factors, left ventricular mass index (LVMI), glomerular filtration rate (GFR) was done. Results . Group without coronary atherosclerosis showed negative correlations of compliance coefficient with LVMI (r=–0.421), positive correlations of Peterson’s elasticity modulus and stiffness index with LVMI (r=0.304, r=0.397). Group with coronary atherosclerosis showed negative correlations of the coefficient of distensibility with LVMI (r=–0.331), Peterson’s elasticity modulus and stiffness index with GFR (r=–0.473, r=–0.469). Positive correlations were found between coefficients of compliance and distensibility with GFR (r=0.418, r=0.473), Peterson’s elasticity modulus and the stiffness index with LVMI (r=0.33, r=0.304). Conclusion . Research reveals relationship between the local elastic properties of the thoracic aorta, GFR and severity of LV hypertrophy in patients with coronary atherosclerosis and the effectiveness of echocardiographic technologies in their assessment.

Aortic invovement in fibromuscular dysplasia. 3-dimensional CT, case-control study. THE ARCADIA-POL BIS study

Abstract Background Fibromuscular dysplasia (FMD) is a non-atherosclerotic arterial disease that manifests as the presence of beaded or focal lesions in medium or small-sized arteries and may also include arterial dissection, aneurysm, and tortuosity. FMD could be revealed in various manifestations, however limited data on the involvement of the thoracic aorta is reported. Purpose To measure and evaluate involvement of thoracic aorta in patients with FMD. Methods We analysed aortas of 144 consecutive patients (mean age 50.2±14.0, 116 women) with confirmed FMD in at least one vascular bed. The control group consisted of 144 (mean age 50.5±14.0, 116 women) age and sex matched individuals. All patients underwent detailed clinical evaluation including angio-CT scan including aortic valve, thoracic aorta and coronary arteries. We measured the aortic valve annulus, sinus of valsalva, sinotubular junction, the diameters of ascending and descending aorta, aortic unfolding, the height of ostium of RCA and LCA and diameter of right and left coronary artery ostia in patients with fibromuscular dysplasia and compared them to matched controls. Results The FMD group had significantly smaller dimensions of aortic valve annulus and sinus of Valsalva than control group (2.3 [2.1–2.6] vs 2.9 [2.7–3.1] p&amp;lt;0,0001; 2.9 [2.7–3.2] vs 3.1 [2.8–3.3] p=0,0011 respectively). In addition the FMD group had a significantly greater mean diameter of the ascending and the descending aorta than the control group (3.1 [2.7–3.3] vs 3 [2.9–3] p=0,0436; 2.4 [2.2–2.7] vs 2.3 [1.8–2.5] p&amp;lt;0,0001 respectively). The height of the ostium of the left and of the right coronary artery was smaller in FMD than in the control group (1.2 [1.1–1.4] vs 1.3 [1.2–1.4] p=0,0001; 1.1 [1–1.3] vs 1.3 [1.1–1.4] p&amp;lt;0,0001 respectively). There was no difference in the diameter of sinotubular junction and the right and the left coronary artery ostias between the FMD and control groups (2.7 [2.5–2.9] vs 2.7 [2.5–2.9]; 0.3 [0.2–0.3] vs 0.3 [0.2–0.3]; 0.3 [0.3–0.3] vs 0.3 [0.3–0.4] respectively). Conclusions Patients with fibromuscular dysplasia display smaller dimensions of aortic valve and larger diameter of ascending and descending aorta as compared to control subjects. Despite the predominant clinical significance of focal pathologies in FMD patients, the disease may display a specific, pan-vascular phenotype. Funding Acknowledgement Type of funding source: None

Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta

To compare a novel Compressed SENSE accelerated ECG- and respiratory-triggered flow-independent 3D isotropic Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT) with standard non-ECG-triggered 3D contrast-enhanced magnetic resonance angiography (CE-MRA) for imaging of the thoracic aorta in patients with connective tissue diseases (CTD) or other aortic diseases using manual and semiautomatic measurement approaches. This retrospective, single-center analysis of 30 patients (June–December 2018) was conducted by two radiologists, who independently measured aortic diameters on modified REACT and CE-MRA using manual (Multiplanar-Reconstruction) and semiautomatic (Advanced Vessel Analysis) measurement tools on seven levels (inner edge): Aortic annulus and sinus, sinotubular junction, mid- and high-ascending aorta, aortic isthmus, and descending aorta. Bland–Altman analysis was conducted to evaluate differences between the mean values of aortic width and ICCs were calculated to assess interobserver agreement. For each level, image quality was evaluated on a four-point scale in consensus with Wilcoxon matched-pair test used to evaluate for differences between both MRA techniques. Additionally, evaluation time for each measurement technique was noted, which was compared applying one-way ANOVA. When comparing both imaging and measurement methods, CE-MRA (mean difference 0.24 ± 0.27 mm) and the AVA-tool (− 0.21 ± 0.15 mm) yielded higher differences compared to modified REACT (− 0.11 ± 0.11 mm) and the MPR-tool (0.07 ± 0.21 mm) for all measurement levels combined without yielding clinical significance. There was an excellent interobserver agreement between modified REACT and CE-MRA using both tools of measurement (ICC > 0.9). Modified REACT (average acquisition time 06:34 ± 01:36 min) provided better image quality from aortic annulus to mid-ascending aorta (p < 0.05), whereas at distal measurement levels, no significant differences were noted. Regarding time requirement, no statistical significance was found between both measurement techniques (p = 0.08). As a novel non-CE-MRA technique, modified REACT allows for fast imaging of the thoracic aorta with higher image quality in the proximal aorta than CE-MRA enabling a reliable measurement of vessel dimensions without the need for contrast agent. Thus, it represents a clinically suitable alternative for patients requiring repetitive imaging. Manual and semiautomatic measurement approaches provided comparable results without significant difference in time need.

The Safety and Efficacy of Extended TEVAR in Acute Type B Aortic Dissection

Thoracic endovascular aortic repair (TEVAR) with endograft coverage from the left subclavian artery to the celiac artery has been hypothesized to increase spinal cord ischemia. This study analyzes the impact of extended coverage on adverse outcomes and aortic remodeling in patients with complicated acute type B aortic dissection (aTBAD). From January 2012 to October 2018, 91 patients underwent TEVAR for aTBAD. Median follow-up was 3.1 (interquartile range, 1.2-4.9) years and was complete in 94% of patients. The extent of aortic endograft coverage was categorized as standard (n= 39) or extended (n= 52). Contrast-enhanced imaging scans were analyzed to determine length of coverage, maximum aortic diameters, and false lumen (FL) status. The mean age was 52.6 ± 13.9 years, and 66% were men. The most common indications for intervention were malperfusion (42%) and refractory pain (34%). Thirteen (14%) patients required a lumbar drain (preoperative: n= 3; postoperative: n= 10). Mean duration between scans was 2.0 ± 1.9 years. Length of aortic coverage was significantly longer in the extended group (241.7 ± 29.2 mm vs 180.8 ± 22.3 mm in the standard group; P < .001). In-hospital and overall mortality were 6% and 11%, respectively. There were no cases of paraplegia, and the incidence of spinal cord ischemia was 3%. After TEVAR, there was a higher incidence of FL obliteration or thrombosis at the distal descending thoracic aorta in the extended group (53% vs 16% in the standard group; P= .004). Extended TEVAR carries a low risk of spinal cord ischemia and improves FL remodeling of the descending thoracic aorta in patients with aTBAD. This strategy may decrease the need for reinterventions on the thoracic aorta in the chronic phase of TBAD.

Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection.

Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. Retrospective case-control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG). 3Mensio Vascular software was used to analyze CTA scans and collect the following measurements; tortuosity index, curvature ratio and the maximum tortuosity of the DTA. The DTA was divided into four equal zones. The maximum tortuosity was divided into three groups: low (<30°), moderate (30°-60°) and high tortuosity (>60°). Compared to the CG, tortuosity was more pronounced in the DG, and even more in the AG, evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31; p < 0.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p < 0.001), maximum tortuosity in degrees (28.17 vs. 33.29 vs. 43.83; p < 0.001) and group of tortuosity (p < 0.001). The maximum tortuosity was further distal for the DG and AG, evidenced by the zone of maximum tortuosity (4A vs. 4B vs. 4B; p < 0.001). This study shows that tortuosity in the DTA is more prominent in diseased aortas, especially in aneurysmal disease. This phenomenon needs to be taken into account during planning of TEVAR to prevent stent graft-related complications and to obtain positive long-term outcome.

Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection: A Quantitative Analysis

Introduction: Tortuosity in the descending thoracic aorta is becoming more important since thoracic endovascular aortic repair (TEVAR) is the gold standard for treating thoracic aortic disease. The literature reports that tortuosity has an influence on the occurrence of endoleaks1. There is some literature defining the angulation and tortuosity of the aortic arch. Recently, a new classification has been published, an extended version of the Ishimaru classification of the four landing zones in the aortic arch2,3. However, zone 4 of the Ishimaru classification and further distally have not been well described yet. The general insight is that tortuosity comes with aging in the descending thoracic aorta. With this report we want to define and classify the tortuosity in the diseased descending thoracic aorta. Methods: A total number of two hundred seven patients were divided into three groups. Sixty-nine healthy patients, with no vascular diseases, were compared with sixty-nine patients with descending thoracic aneurysm (DTA) and sixty-nine patients with type B aortic dissection (TBD). CTA scans, with thin cut slices (1.0 or 1.5 mm) were analyzed with 3Mensio Vascular software and the following measurements were collected; tortuosity index (length of the centre lumen line divided by the true length), curvature ratio (outer curvature length divided by length centre lumen line), the maximum and minimum angulation in degrees of the descending thoracic aorta and the level of vertebrae of the maximum and minimum angulation. The descending thoracic aorta was analyzed from two cm distal to the Left Subclavian Artery up to the Celiac Trunk and was divided into four zones of equal length, from proximal to distal, numbered one to four. Additionally, the maximum angulation was divided into three groups: low (< 30°), moderate (30° – 60°) and high angulation (> 60°). Results: The mean age of the Healthy group (HG) was 68.3 years old, in the Aneurysm group (AG) 72.2 and in the Dissection group (DG) 64.1. Compared to the HG, tortuosity was more pronounced in the DG, and even more in the AG, as evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31, respectively; p < 0.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p < 0.001), maximum angulation in degrees (28.17 vs. 33.29 vs. 43.83; p < 0.001), and group of angulation (1.00 vs. 2.00 vs. 1.00; p < 0.001). Additionally, compared to HG, the location of maximum angulation was further distal for the DG and even further in the AG, as evidenced by the vertebral level of maximum angulation (5.00 vs. 7.00 vs. 8.00; p < 0.001), and zone of maximum angulation (1.00 vs. 2.00 vs. 2.00; p < 0.001). Conclusion: This study shows that tortuosity in the descending thoracic aorta becomes even more prominent in diseased aortas, especially for patients with aneurysmal diseases. The upcoming endovascular technology and interventions have to handle with this phenomenon in order to prevent aortic complications and to obtain positive long-term outcome.

Modern ultrasound assessment of elastic properties of the thoracic aorta in patients with coronary atherosclerosis

The main goal of echocardiography is not to diagnose CAD or changes associated with CAD, but to reveal non-coronary heart disease. Currently, the development of ultrasound technologies makes it possible to expand the standard echocardiography by evaluating the elastic properties of the thoracic aorta. Due to the fact that studies show correlation between the presence and severity of coronary atherosclerosis with changes in the elastic properties of the thoracic aorta, this solution improves the usefulness of echocardiography in patients with CAD. The most promising in assessing the elastic properties of the thoracic aorta during the traditional transthoracic echocardiography are tissue doppler imaging (TDI) and color M-mode. Color M-mode is a technology that is mainly used in echocardiography to assess the compliance of the left ventricle by examining the mitral inflow propagation velocity. This technology may be used in the descending part of the thoracic aorta, where it will similarly display the elastic properties.

P1820New parameters for the evaluation of mechanic and elastic properties of the aortic root in Marfan Syndrome

Abstract Background Elastic properties of the thoracic aorta in patients with Marfan Syndrome (MS) have already been evaluated with classic echocardiographic parameters. In the latest years the use of Speckle-Tracking (STE) ecocardiography has been widely extended. Our aim is to describe and provide new parameters of aortic deformation measured by STE in patients with MS. Methods 95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. We measured classic parameters of the aortic root using 2D echocardiography. We calculated the posterior aortic wall systolic excursion at the sinuses of Valsalva and ascending aorta using M Mode in TDI colour; with ST 2D ecocardiography we measured the aortic strain at the sinuses of Valsalva (SV) and the anterior and posterior aortic wall displacement at the SV. Aortic distensibility was calculated using the formula: 1000 * (Ds − Dd)/Dd * 1/(Ps − Pd) in mmHg–1 (Ds: systolic and Dd: diastolic diameters, Ps systolic and Pd diastolic blood pressure). Aortic stiffness index was calculated as Ln((Ps/Pd)/(Ds-Dd)/Dd)). Results As shown in the table bellow, patients with MS had lower aortic strain, aortic anterior and posterior wall displacement and impaired aortic distensibility and stiffness index compared to healthy controls. We found a strong negative linear correlation between aortic root diameter at the SV and aortic root strain (r=−0.56, figure 1). Results of statistical analysis MS (n=95) Controls (n=32) p Age (years) 32.84±12.35 32.41±7.98 0.85 Aortic root diameter at the sinuses of Valsalva (mm) 38.82±5.35 30.92±3.65 &lt;0.001 Aortic root strain (%) 4.66±2.45 9.19±2.49 &lt;0.001 Anterior aortic wall displacement STE (mm) 10.39±3.64 13.10±2.26 &lt;0.001 Posterior aortic wall displacement STE (mm) 9.02±2.87 11.04±1.82 &lt;0.001 Aortic distensibility 0.98±0.46 1.37±0.72 0.01 Aortic stiffness index 3.74±0.43 3.47±0.51 0.01 MS = Marfan Syndrome; STE = Speckle Tracking Ecocardiography. Figure 1. Dispersion plot Conclusions Our results suggest that aortic deformation and displacement obtained by STE echocardiography is impaired in MS, showing a reduced distensibility and an increased stiffness of the aortic wall, with a strong negative correlation between aortic root dilation and aortic strain. All these parameters may be useful as additional tools for the diagnosis and follow-up of Marfan patients, and could be useful to to improve the echocardiographic evaluation of the aortic root.

Can Frozen Elephant Trunk Cure Type I Dissection Confined to Thoracic Aorta in Marfan Syndrome?

This study sought to evaluate the long-term impact of frozen elephant trunk (FET) on the distal aorta of patients with Marfan syndrome (MFS) who had type I dissection confined to the thoracic aorta (above the diaphragmatic hiatus). Between 2003 and 2016, 42 patients with MFS (Ghent or revised Ghent criteria) (age 33.3 ± 8.9 years; 27 men; 64.3%) sustaining type I dissection above the diaphragmatic hiatus involving the aortic arch (22 acute; 52.4%) underwent total arch replacement and FET. Dissection extended distally to the mid-descending aorta in 32 (76%) and to above the diaphragmatic hiatus in 10 (24%) patients. Operative mortality was 4.8% (2 of 42). Follow-up was 100% at 6.3 ± 3.0 years. Maximal aortic sizes at the mid-descending aorta, diaphragmatic hiatus, renal arteries, and largest segment of abdominal aorta were 22.8, 21.1, 19.1, and 19.9 mm preoperatively and 23.1, 22.0, 19.8, and 22.4 mm on the latest computed tomographic angiography. Dilation and complete remodeling of the distal aorta occurred in 10.0% (4 of 40) and 90% (36 of 40) of patients, respectively. One late death occurred, and 3 distal reoperations were performed. Preoperative abdominal aortic maximal aortic size was predictive of distal dilatation (mm) (hazard ratio, 1.78; P= .021) and reoperation (≥25 mm vs <25 mm) (hazard ratio, 12.88; P= .037). At 10 years, freedom from dilation, reoperation, and death were 69.8%, 78.1%, and 90.0%, respectively. At 8 years, the rates of death, reoperation, and reoperation-free survival were 10%, 11%, and 79%, respectively. The FET technique has a positive remodeling impact on type I dissection confined to the thoracic aorta in patients with MFS. This study adds evidence supporting the safety and durability of this extended approach for type I aortic dissection in MFS.