Cystic medial necrosis: pathological findings and clinical implications

Yuan, Shi‐Min; Hua, Jing

doi:10.1590/s0102-76382011000100019

Cited by 68 publications

(60 citation statements)

References 53 publications

(63 reference statements)

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“…14,29 A thin, fragile, and dilated aorta is typically associated with histopathologic changes such as MD. 30 Nearly all histological examinations of excised aortic tissues in our study showed evidence of MD, atherosclerosis, or both. MD is characterized by an accumulation of basophilic ground substance (mucopolysaccharides) in the media with cystlike lesions, disruptions of collagen, elastic fragmentation, and apoptosis or necrosis of smooth muscle cells that results in weakening of the aortic tissue and higher wall stress.…”

Section: Discussionmentioning

confidence: 54%

“…34 The presence of MD is typical of connective tissue diseases, but it was shown to precede aortic dissection in non-Marfan aortas as well. 19,30 Chronic hypertension causes intimal thickening, fibrosis, calcification, and extracellular fatty acid deposition that affect arterial wall composition. 19,31,32 In parallel, the extracellular matrix undergoes accelerated degradation, apoptosis, and elastolysis with hyalinization of collagen.…”

Section: Discussionmentioning

confidence: 99%

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Type A Aortic Dissection After Nonaortic Cardiac Surgery

et al. 2013

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A cute type A aortic dissections (AADs) are life-threatening conditions that are conventionally treated with emergency operations. Population-based studies suggest an incidence of ≈20 to 30 cases per million people per year which roughly translates to an estimated >6000 new AAD cases annually in the United States and >14 000 in Europe. [1][2][3][4][5] The clinical presentation, natural history, management, and outcome of spontaneous AADs are well described.2,5-7 Despite improvements in imaging, surgical techniques, and management, the overall in-hospital mortality of patients with spontaneous acute AAD remains high with a range of 15% to 32%, 7-10 with early death resulting mainly from rupture and tamponade. Editorial see p 1593 Clinical Perspective on p 1611AAD can complicate routine cardiac surgery unexpectedly at any time, either intraoperatively and early or late afterward, suddenly converting a low-risk elective procedure into a highrisk situation with excessive operative mortality.11,12 Previous reports suggest that AAD occurs in 0.12% to 0.16% of patients Background-Cardiac surgery with cardiopulmonary bypass is associated with mechanical manipulation of the ascending aorta that occasionally leads to type A aortic dissection (AAD). Methods and Results-One hundred three patients with surgical repair for AAD following nonaortic cardiac surgery were identified. With the use of logistic regression modeling, coronary artery bypass surgery (CABG), either isolated or combined with another procedure in the initial operation, was associated with significantly higher operative mortality in comparison with patients with non-CABG procedures at the time of AAD repair both for all patients (odds ratio, 2.90; 95% confidence interval, 1.09-7.72; P=0.033) and for patients with acute and chronic AAD ≥30 days after the initial operation (odds ratio, 3.62; 95% confidence interval, 1.13-11.54; P=0.03). In patients who developed AAD late after the initial operation, operative mortality was highest in patients without preoperative coronary angiography and appropriate management of their native coronary artery disease and graft disease (odds ratio, 5.36; 95% confidence interval, 1.68-17.0; P=0.002). Nearly all the intimal dissection tears were located at sites of previous surgical trauma. Most of the ascending aortas that had dissected initially had a diameter ≥40 mm with histological evidence of medial degeneration in resected tissue samples. Conclusions-In patients who have undergone previous cardiac surgery, preexisting aortic wall pathology contributes to AAD with typical intimal damage at sites of mechanical trauma. The operative mortality was the highest in patients with previous CABG in comparison with patients with non-CABG procedures. Preoperative coronary angiography and operative management of native coronary and graft disease were significantly associated with outcome in patients with previous CABG. (Circulation. 2013;128:1602-1611.)

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Type A Aortic Dissection After Nonaortic Cardiac Surgery

et al. 2013

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“…Medial degeneration is not the cause of a dissection, but rather a consequential pathological finding or a side effect caused by a primary syndrome. 25 Medial degeneration is characterized by disruption of the lamellar organization of elastic fibers, accumulation of basophilic ground substance with cyst-like lesions, degradation of the extracellular matrix (ECM), including elastin fragmentation and disruptions of collagen, and apoptosis of vascular smooth muscle cells (VSMC). 25 In patients with TAA undergoing surgery, the prevalence of medial degeneration is 6%, whereas it rises up to 100% after having undergone combined aortic and aortic valve surgery.…”

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confidence: 99%

Genetics of Thoracic Aortic Aneurysm

2013

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Aortic aneurysm, including both abdominal aortic aneurysm and thoracic aortic aneurysm, is the cause of death of 1% to 2% of the Western population. This review focuses only on thoracic aortic aneurysms and dissections. During the past decade, the genetic contribution to the pathogenesis of thoracic aortic aneurysms and dissections has revealed perturbed extracellular matrix signaling cascade interactions and deficient intracellular components of the smooth muscle contractile apparatus as the key mechanisms. Based on the study of different Marfan mouse models and the discovery of several novel thoracic aortic aneurysm genes, the involvement of the transforming growth factor-β signaling pathway has opened unexpected new avenues. Overall, these discoveries have 3 important consequences. First, the pathogenesis of thoracic aortic aneurysms and dissections is better understood, although some controversy still exists. Second, the management strategies for the medical and surgical treatment of thoracic aortic aneurysms and dissections are becoming increasingly gene-tailored. Third, the pathogenetic insights have delivered new treatment options that are currently being investigated in large clinical trials.

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“…Thoracic aortic intima media thickness reaches 55-60 laminar units and this segment of aorta has both avascular and vascularizing zones, while AAA media is totally avascular as it consists of 28-32 laminar units [15]. In DTA, media thickness increases at birth of a patient due to the synthesis of laminar units, whereas in AAA due to the enlargement of the existing units.…”

Section: Discussionmentioning

confidence: 99%

Ways to Correct Indications for Surgical Treatment of Atherosclerotic Descending Aortic Aneurysms

Krylov¹

2017

ASS

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Recent studies suggest that the development of atherosclerotic descending aortic aneurysms (DAA) is a complicated process, which occurs due to a polymorphic nature of aortic wall abnormalities. They overlap and contribute to a wide variety of clinical manifestations. The inflammatory process may be the main reason for a rapid growth and rupture of the aneurysm. It also involves a mechanism of complex adhesion comprising of acute-phase proteins to low-density lipoproteins (LDLPs) as atherosclerotic lesions. This process occurs in the presence of connective tissue disorders, aortic wall focal cystic medianecrosis, poor management of arterial hypertension, aging, and reduced compliance. Therefore, the surgical treatment modality to treat DAA becomes less appealing. Additionally, it is not feasible to make indications for surgery based solely on linear aneurysmal diameter. However, medical correction has no contraindications for use.

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Cystic medial necrosis: pathological findings and clinical implications

Cited by 68 publications

References 53 publications

Type A Aortic Dissection After Nonaortic Cardiac Surgery

Type A Aortic Dissection After Nonaortic Cardiac Surgery

Genetics of Thoracic Aortic Aneurysm

Ways to Correct Indications for Surgical Treatment of Atherosclerotic Descending Aortic Aneurysms

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