Limited role of aortic size in the genesis of acute type A aortic dissection

Massimo Massetti, Eugenio Neri, Lucio Barabesi, Dimitrios Buklas, Luca A. Vricella, Antonio Benvenuti, Enrico Tucci, Carlo Sassi

Risultato della ricerca: Contributo in rivistaArticolo in rivista

62 Citazioni (Scopus)

Abstract

Objective: Increased dimension of the aortic root and proximal aorta is considered a significant risk factor for catastrophic events that involve the ascending aorta. The objective of this study was to determine the possible correlation between pre-dissection aortic diameter and the occurrence of Stanford type A aortic dissection. Methods: Samples of dissected ascending aortas were obtained from 220 patients at the time of their operation. Two groups were identified: patients with connective tissue disorders (Group 1, n = 94) and those without (Group 2, n = 126). Measurements of the true (intimal) lumen were conducted and extrapolated as reliable approximation of pre-dissection aortic diameter. The possible association of intimal diameter with anthropometric and demographic data was analyzed. Results: Median aortic diameter was, respectively, 41.8 and 41.3 mm for patients with and without connective tissue disorders (41.4 mm for the entire cohort). Data analysis indicated that 57% of patients had aortic diameter above 40 mm, while patients with frank aneurysm accounted only for 10%; this proportion was higher in Group 1 compared to Group 2 (17.2% vs 4.7%). Poor or no correlation was demonstrated between aortic size and any of the anthropometric or demographic variables essayed. Significant subgroup differences were found among patients with a history of cigarette smoking, hypertension, diabetes, chronic renal insufficiency, and bicuspid aortic valve. Conclusion: Although aortic diameter remains a strong indication for preventive surgery in patients with inherited connective tissue disorders, acute aortic dissection occurs rarely in the setting of true ascending aortic aneurysms, and despite normal or near-normal aortic size in more than one-third of subjects. Dissection superimposing on small aortic diameters can be regarded as an expression of substantial functional tissue susceptibility to aortic catastrophic events. © 2005 Elsevier B.V. All rights reserved.
Lingua originaleEnglish
pagine (da-a)857-863
Numero di pagine7
RivistaEuropean Journal of Cardio-thoracic Surgery
Volume28
DOI
Stato di pubblicazionePubblicato - 2005

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Dissecting
  • Anthropometry
  • Aorta
  • Aortic Aneurysm
  • Cardiology and Cardiovascular Medicine
  • Dissection
  • Ehlers-Danlos Syndrome
  • Female
  • Humans
  • Hypertension
  • Kidney Failure, Chronic
  • Male
  • Marfan Syndrome
  • Marfan syndrome
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive
  • Risk Factors
  • Smoking
  • Surgery

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