Journal Article
How does the ascending aorta geometry change when it dissects?
Rylski, B; Blanke, P; Beyersdorf, F; Desai, ND; Milewski, RK; Siepe, M; Kari, FA; Czerny, M; Carrel, T; Schlensak, C; Krüger, T; Mack, MJ; Brinkman, WT; Mohr, FW; Etz, CD; Luehr, M; Bavaria, JE
Journal of the American College of Cardiology
ISSN: 0735-1097
EISSN: 1558-3597
OBJECTIVES: To delineate changes in aortic geometry and diameter due to dissection.
BACKGROUND: Aortic diameter is the major criterion for elective ascending aortic replacement for dilated ascending aortas to prevent aortic dissection. However, recommendations are based on clinical experience and observation of diameters of previously dissected aortas.
METHODS: Six tertiary centers on two continents reviewed their acute aortic dissection type A databases, containing 1821 patients. Included were all non-Marfan, non-bicuspid patients who had undergone computed tomography angiography less than 2 years before and immediately after aortic dissection onset. Aortic geometry before and after dissection onset were compared.
RESULTS: Altogether, 63 patients were included (27/36 spontaneous/retrograde dissections, mean age 68 (57, 77) years, 54% males). In all but one patient maximum ascending aortic diameter was <55mm before aortic dissection onset. The largest increase in diameter and volume induced by the dissection were observed in the ascending aorta (40.1 (36.6, 45.3) versus 52.9 (46.1, 58.6) mm; +12.8 mm, P<0.001; 124.0 (90.8, 162.5) versus 171.0 (147.0, 197.0) cm(3), +47 cm(3), P<0.001). Mean aortic arch diameter increased from 39.8 (30.5, 42.6) to 46.4 (42.0, 51.6) mm (+6.6 mm, P<0.001) and descending thoracic aorta diameter from 31.2 (27.0, 33.3) to 34.9 (30.9, 39.5) mm (+3.7mm, P<0.001). Changes in thoracic aorta geometry were similar for spontaneous and retrograde etiology.
CONCLUSIONS: Geometry of the thoracic aorta is affected by aortic dissection, leading to increase in diameter, most pronounced in the ascending aorta. Both spontaneous and retrograde dissection result in similar aortic geometry changes.
aorta; computed tomography; dissection; surgery