Invited Commentary

Ge, Liang; Tseng, Elaine E.

doi:10.1016/j.athoracsur.2013.07.087

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…24 Thus, aneurysm tissue is weaker in the longitudinal direction and a longitudinal break could result in the typical transverse tear seen in acute dissection. 25 Longitudinal wall stresses in our Marfan aTAA were greatest in the sinuses, followed by STJ, and AscAo. Future studies will be required to determine tensile stress at failure in the longitudinal direction of Marfan aTAA to serve as a benchmark by which to compare patient-specific longitudinal wall stresses by FEA.…”

Section: Collagen-embedded Hyperelastic Materialsmentioning

confidence: 68%

Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms

Xuan

D’Souza

Wang

et al. 2022

The Annals of Thoracic Surgery

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Section: Collagen-embedded Hyperelastic Materialsmentioning

confidence: 68%

Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms

Xuan

D’Souza

Wang

et al. 2022

The Annals of Thoracic Surgery

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“…Although circumferential stresses are significantly greater than longitudinal stresses, the lower longitudinal strength in relationship to circumferential strength explains the reason why dissection entry tears begin transversely. 23 Gleason’s group 19 reported a longitudinal tensile strength of 54N/cm 2 (540 kPa). Tensile strength in relation to wall stress could estimate dissection or rupture risk.…”

Section: Discussionmentioning

confidence: 99%

Association of diameter and wall stresses of tricuspid aortic valve ascending thoracic aortic aneurysms

Gomez¹,

Wang²,

Xuan³

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Ascending thoracic aortic aneurysms carry a risk of acute type A dissection. Elective repair guidelines are designed around size thresholds, but the 1-dimensional parameter of maximum diameter cannot predict acute events in small aneurysms. Biomechanically, dissection can occur when wall stress exceeds strength. Patient-specific ascending thoracic aortic aneurysm wall stresses may be a better predictor of dissection. Our aim was to compare wall stresses in tricuspid aortic valve-associated ascending thoracic aortic aneurysms based on diameter.Methods: Patients with tricuspid aortic valve-associated ascending thoracic aortic aneurysm and diameter 4.0 cm or greater (n ¼ 221) were divided into groups by 0.5cm diameter increments. Three-dimensional geometries were reconstructed from computed tomography images, and finite element models were developed taking into account prestress geometries. A fiber-embedded hyperelastic material model was applied to obtain longitudinal and circumferential wall stress distributions under systolic pressure. Median stresses with interquartile ranges were determined. The Kruskal-Wallis test was used for comparisons between size groups.Results: Peak longitudinal wall stresses for tricuspid aortic valve-associated ascending thoracic aortic aneurysm were 290 (265-323) kPa for size 4.0 to 4.4 cm versus 330 (296-359) kPa for 4.5 to 4.9 cm versus 339 (320-373) kPa for 5.0 to 5.4 cm versus 318 (293-351) kPa for 5.5 to 5.9 cm versus 373 (363-449) kPa for 6.0 cm or greater (P ¼ 8.7e-8). Peak circumferential wall stresses were 460 (421-543) kPa for size 4.0 to 4.4 cm versus 503 (453-569) kPa for 4.5 to 4.9 cm versus 549 (430-588) kPa for 5.0 to 5.4 cm versus 540 (471-608) kPa for 5.5 to 5.9 cm versus 596 (506-649) kPa for 6.0 cm or greater (P ¼ .0007).Conclusions: Circumferential and longitudinal wall stresses are higher as diameter increases, but size groups had large overlap of stress ranges. Wall stress thresholds based on aneurysm wall strength may be a better predictor of patient-specific risk of dissection than diameter in small ascending thoracic aortic aneurysms.

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Wall stress on ascending thoracic aortic aneurysms with bicuspid compared with tricuspid aortic valve

Xuan

Wang

Liu

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Circumferential and longitudinal stresses were greater in bicuspid aortic valve- than tricuspid aortic valve-ascending thoracic aortic aneurysms and were more pronounced in the sinotubular junction. Peak wall stress did not correlate with bicuspid aortic valve-ascending thoracic aortic aneurysm diameter, suggesting diameter alone in this population may be a poor predictor of dissection risk. Our results highlight the need for patient-specific aneurysm wall stress analysis for accurate dissection risk prediction.

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Invited Commentary

Cited by 3 publications

References 6 publications

Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms

Patient-Specific Biomechanics in Marfan Ascending Thoracic Aortic Aneurysms

Association of diameter and wall stresses of tricuspid aortic valve ascending thoracic aortic aneurysms

Wall stress on ascending thoracic aortic aneurysms with bicuspid compared with tricuspid aortic valve

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