The ascending aortic aneurysm: When to intervene?

Saliba, E.; Sia, Ying Tung; Dore, Annie; Hamamsy, Ismael El

doi:10.1016/j.ijcha.2015.01.009

Cited by 69 publications

(54 citation statements)

References 60 publications

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“…Aortic size: aortic diameter did not significantly correlate with mechanical and morphological tissue properties in this study, agreeing with recently published results (7,18). Current guidelines recommend surgical intervention at an aortic diameter greater than 5.5 cm, 5.0 cm for MFS patients (26,27); similarly, Pape et al show that type A dissections occur at a mean diameter of 5.31 cm, below the 5.5 cm cutoff (28). Additionally, Coady et al (29) and Davies et al (30) even show an increased risk of complications at aortic sizes smaller than 4 cm for descending TAAs, well under the 5.5 cm cutoff, also supported by the similar mean 5-year survival rates for patients with 4.0-5.9 cm aortic diameters (31).…”

Section: Agingsupporting

confidence: 92%

Biomechanical properties of the thoracic aorta in Marfan patients

Sulejmani¹,

Pokutta-Paskaleva²,

Ziganshin³

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Marfan syndrome (MFS), a genetic disorder of the connective tissue, has been strongly linked to dilation of the thoracic aorta, among other cardiovascular complications. As a result, MFS patients frequently suffer from aortic dissection and rupture, contributing to the high rate of mortality and morbidity among MFS patients. Despite the significant effort devoted to the investigation of mechanical and structural properties of aneurysmal tissue, studies on Marfan aneurysmal biomechanics are scarce. Ex vivo mechanical characterization of MFS aneurysmal tissue can provide a better insight into tissue strength outside the physiologic loading range and serve as a basis for improved risk assessment and failure prediction. Methods:The mechanical and microstructural properties of MFS aneurysmal thoracic aorta (MFS, n=15, 39.5±3.91 years), non-MFS aneurysmal thoracic aorta (TAA, n=8, 52.8±4.9 years), healthy human thoracic aorta (HH, n=8, 75.4±6.1 years), and porcine thoracic aorta (n=10) are investigated. Planar biaxial tensile testing and uniaxial failure testing were utilized to characterize the mechanical and failure properties of the tissue, respectively. Verhoeff-Van Gieson (VVG) and PicroSirius Red stains were utilized to visualize the elastin and collagen fiber architecture, respectively.Results: MFS tissue was found to have age-dependent but diameter-independent mechanical, structural, and morphological properties, also showing extensive elastin fiber degradation. Non-MFS thoracic aneurysmal aorta was thicker and stiffer than age-matched MFS tissue. Moreover, non-MFS thoracic aneurysmal mechanics resembled closely the mechanics of older healthy human tissue. Younger MFS tissue (<40 years) exhibited similar mechanical and structural properties to aged porcine tissue.Conclusions: Both age and aneurysmal presence were found to be factors associated with increased stiffness in aortic tissue, and aortic diameter was not a significant determinant of mechanical property deterioration. Additionally, the presence of MFS was found to induce stiffening of the thoracic aorta, although not to the extent of the non-MFS aneurysm.

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Section: Agingsupporting

confidence: 92%

Biomechanical properties of the thoracic aorta in Marfan patients

Sulejmani¹,

Pokutta-Paskaleva²,

Ziganshin³

et al. 2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…It is unethical to harvest human aortic tissue samples at earlier stages of the disease, so the progressive changes in mechanical properties are unknown. Consequently, the assessment for prophylactic surgical intervention with an aortic graft relies on the patient’s aortic diameter, 44 which provides a rule of thumb at best. Our time-resolved, layer-specific mechanical properties of the MFS mouse aorta help provide input variables, such as intimal and medial mechanics, necessary for developing computational models of aortic dilation, aneurysm, and rupture.…”

Section: Discussionmentioning

confidence: 99%

“…31, 44 However, such criteria are not always sufficient to evaluate the risk of dissection. Finite element analysis (FEA) has been implemented to evaluate wall stress and assess aortic aneurysm rupture risk.…”

Section: Introductionmentioning

confidence: 99%

Losartan Attenuates Degradation of Aorta and Lung Tissue Micromechanics in a Mouse Model of Severe Marfan Syndrome

et al. 2016

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Marfan syndrome (MFS) is an autosomal dominant disease of the connective tissue due to mutations in the fibrillin-1 gene (FBN1). This study aimed at characterizing microelastic properties of the ascending aorta wall and lung parenchyma tissues from wild type (WT) and age-matched Fbn1 hypomorphic mice (Fbn1mgR/mgR mice) to identify tissue-specific biomechanical effects of aging and disease in MFS. Atomic force microscopy (AFM) was used to indent lung parenchyma and aortic wall tissues, using Hybrid Eshelby Decomposition analysis to extract layer-specific properties of the intima and media. The intima stiffened with age and was not different between WT and Fbn1mgR/mgR tissues, whereas the media layer of mutant aortas showed progressive structural and mechanical degradation with a modulus that was 50% softer than WT by 3.5 months of age. Similarly, mutant mice displayed progressive structural and mechanical deterioration of lung tissue, which was over 85% softer than WT by 3.5 months of age. Chronic treatment with the angiotensin type I receptor antagonist, losartan, attenuated the aorta and lung tissue degradation, resulting in structural and mechanical properties not significantly different from age-matched WT controls. By revealing micromechanical softening of elastin-rich aorta and lung tissues with disease progression in fibrillin-1 deficient mice, our findings support the use of losartan as a prophylactic treatment that may abrogate the life-threatening symptoms of MFS.

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“…The length of pulse wave propagation L is the length from the heart to the aortic arch. In this study, L is defined 5cm, which is the length of the ascending aorta [10] because we are not able to measure that length noninvasively for each person.…”

Section: Proposed Measurement Methodsmentioning

confidence: 99%

Development of Non-Restraint Blood Pressure Measurement Method Utilizing PWV

Asakura¹,

Sankai²

2017

IJPMBS

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Abstract-Hypertension is a major risk factor of ischemic heart disease and cerebrovascular disease. In order to prevent hypertension, it is important to measure blood pressure regularly. Non-restraint blood pressure measurement method would make daily measurement convenience. The purpose of this study is to develop a novel non-restraint measurement method and device of PWV (Pulse Wave Velocity) that relates to blood pressure strongly and verify the feasibility of measuring PWV with the proposed method. We developed pressure plethysmogram sensors that could detect BCG (Ballistocardiogram), and attached it on a chair. PWV was calculated from two characteristic points of BCG, which were the rising point of H wave and the bottom of I wave. In the experiment, developed system is applied to five participants, and measured values of PWV are increased according to values of systolic blood pressure. In addition, the correlation coefficients are enough to imply the relationship between PWV measured by our device and systolic blood pressure. In conclusion, we developed a novel non-restraint measurement method and device of PWV that relates to blood pressure strongly and confirmed that correlation between systolic blood pressure and PWV by using this method and device.  Index Terms-blood pressure, pulse wave velocity (PWV), ballistocardiogram (BCG), non-restraint measurement

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The ascending aortic aneurysm: When to intervene?

Cited by 69 publications

References 60 publications

Biomechanical properties of the thoracic aorta in Marfan patients

Biomechanical properties of the thoracic aorta in Marfan patients

Losartan Attenuates Degradation of Aorta and Lung Tissue Micromechanics in a Mouse Model of Severe Marfan Syndrome

Development of Non-Restraint Blood Pressure Measurement Method Utilizing PWV

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