How Does the Ascending Aorta Geometry Change When It Dissects?

作者：Rylski Bartosz^*; Blanke Philipp; Beyersdorf Friedhelm; Desai Nimesh D; Milewski Rita K; Siepe Matthias; Kari Fabian A; Czerny Martin; Carrel Thierry; Schlensak Christian; Krueger Tobias; Mack Michael J; Brinkman William T; Mohr Friedrich W; Etz Christian D; Luehr Maximilian; Bavaria Joseph E

来源：Journal of the American College of Cardiology, 2014, 63(13): 1311-1319.

DOI：10.1016/j.jacc.2013.12.028

• aorta
• computed tomography
• dissection
• surgery

Objectives The purpose of this study is 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 made on the basis of clinical experience and observation of diameters of previously dissected aortas.
Methods Six tertiary centers on 2 continents reviewed their acute aortic dissection type A databases, which contained 1,821 patients. Included were all non-Marfan patients with nonbicuspid aortic valves who had undergone computed tomography angiography < 2 years before and within 12 h after aortic dissection onset. Aortic geometry before and after dissection onset were compared.
Results Altogether, 63 patients were included (27 spontaneous and 36 retrograde dissections, median age 68 [57; 77] years; 54% were men). In all but 1 patient, maximum ascending aortic diameter was < 55 mm 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] mm vs. 52.9 [46.1; 58.6] mm, +12.8 mm; p < 0.001; 124.0 [90.8; 162.5] cm(3) vs. 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) mm 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) mm to 34.9 (30.9; 39.5) mm (+3.7 mm; 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 an increase in diameter that is most pronounced in the ascending aorta. Both spontaneous and retrograde dissection result in similar aortic geometry changes.

• 出版日期2014-4-8