A bicuspid aortic valv sign in ascending aorta: An acute circumferential type 1 aortic dissection with intimo-intimal intussusception.
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SUBMITTER: Altun I
PROVIDER: S-EPMC8114625 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Genome wide DNA methylation profiling of ascending aorta tissue samples from normal, aortic dissection and bicuspid aortic valve patients with aortic dilation. The Illumina Infinium 450k Human DNA methylation Beadchip was used to obtain DNA methylation profiles across more than 450,000 CpGs in ascending aorta samples. Samples included 6 normal donors, 12 patients with aortic dissection and 6 patients with bicuspid aortic valve and dilated aorta.
2019-07-11 | GSE84274 | GEO
Project description:Intimo-intimal intussusception is a very rare and unusual complication of type A dissections, typically noted on TEE exam. It has been reported in a few cases in the cardiothoracic surgical and radiology literature, and even more rarely in the cardiac anesthesia/TEE literature. This uncommon variation occurs in severe, acute, type A dissections when the ascending aortic intima circumferentially strips and detaches from the media and forms a tube-like structure which may either prolapse antegrade into the ascending aortic lumen or retrograde into the left ventricular (LV) outflow tract and LV cavity. Antegrade intussusceptions may be severe enough to partially or completely occlude the ostia of the innominate, left common carotid, and left subclavian arteries producing acute neurologic symptoms. Retrograde intussusceptions may severely impair LV filling in diastole, can worsen aortic insufficiency, mitral regurgitation, as well as produce occlusion of the coronary ostia and acute coronary ischemia. Here, we describe the incidental finding of a retrograde intussusception that was not visualized on computed tomography scan but by intraoperative TEE examination, in a patient with a severe, extensive type A dissection.
| S-EPMC4881657 | biostudies-literature
Project description:BackgroundAcute aortic circumferential dissection with proximal intimo-intimal intussusception is a rare and potentially lethal occurrence. We here report a case and review previous works to better understand this particular condition and help surgeons to determine accurate diagnosis and optimal intervention strategies by intraoperative transesophageal echocardiography (TEE).Case presentationWe report a case of a 46-year-old male who complained of sudden substernal chest pain. Stanford type A acute aortic dissection with proximal intimo-intimal intussusception was confirmed by contrast-enhanced computed tomography (CECT), transthoracic echocardiography (TTE), and TEE. We found the intimal flap prolapsed into the left ventricle outflow tract (LVOT), which caused severe aortic regurgitation (AR) and obstructed the ostia of the coronary arteries. Given the preexisting aneurysmal dilatation of aortic sinus and severity of aortic root and arch dissection, Bentall procedure and Sun's procedure were performed for our patient.ConclusionsIntraoperative TEE used by anesthesiologists here played an increasingly valuable role in the determination of acute aortic dissection. Hence, it is necessary that TEE screening is routinely performed in patients with acute aortic dissection to provide valuable information for facilitating surgical strategies.
| S-EPMC8317293 | biostudies-literature
Project description:Individuals with a bicuspid aortic valve (BAV) are at significantly higher risk of developing aortic complications than individuals with tricuspid aortic valves (TAV) and defective signaling during the embryonic development and/or life time exposure to abnormal hemodynamic have been proposed as underlying factors. However, an explanation for the molecular mechanisms of aortopathy in BAV has not yet been provided. We combined proteomics, RNA analyses, immunohistochemistry, and electron microscopy to identify molecular differences in samples of non-dilated ascending aortas from BAV (N?=?62) and TAV (N?=?54) patients. Proteomic analysis was also performed for dilated aortas (N?=?6 BAV and N?=?5 TAV) to gain further insight into the aortopathy of BAV. Our results collectively showed the molecular signature of an endothelial/epithelial-mesenchymal (EndMT/EMT) transition-like process, associated with instability of intimal cell junctions and activation of RHOA pathway in the intima and media layers of ascending aorta in BAV patients. We propose that an improper regulation of EndMT/EMT during the spatiotemporally related embryogenesis of semilunar valves and ascending aorta in BAV individuals may result in aortic immaturity and instability prior to dilation. Exasperation of EndMT/EMT state in post embryonic life and/or exposure to non-physiological hemodynamic could lead to the aneurysm of ascending aorta in BAV individuals.
| S-EPMC5078843 | biostudies-literature
Project description:OBJECTIVES: Aneurysm diameter and growing rate does not represent a definite parameter for operation in bicuspid aortic valve (BAV), ascending aortic aneurysm and normal root patients. Thus, we investigated histological and immunohistochemical aspects of different segments of ascending aorta (precisely, aortic root without dilatation, aneurysmatic tubular portion, dissected ascending aorta) and genetic features of patients with BAV and ascending aorta complication (aneurysm or dissection). METHODS: Aorta tissue samples of 24 BAV patients were examined. The patients comprised of 18 men and 6 women; the mean age was 54.2 ± 14.3 years. All patients underwent composite aortic root replacement (button Bentall operation). Multiple histological sections were prepared from each aortic specimen. The evaluated features included elastic fibre fragmentation, cystic medial change, smooth muscle cell necrosis, medial fibrosis, and the markers of medial apoptosis and the metalloproteinases. Furthermore, genetic risk factors were also investigated. RESULTS: The same medial degenerative lesions in tissue samples of different aorta segments (precisely of aortic root without dilatation, and aneurysmatic ascending aorta portion) were observed. More significant associations between single nucleotide polymorphisms (-786T/C endothelial nitric oxide synthase enzyme, D/I angiotensin-converting enzyme, -1562C/T metalloproteinase-9 and -735C/T metalloproteinase-2) and aneurysm risk were detected in BAV patients than in controls. CONCLUSIONS: Based on our histological and genetic data, we underline that a surgical approach in patients with BAV, ascending aortic aneurysm and normal root, should consider not only the diameter of the aneurysmatic aortic portion but also the histological features of the whole ascending aorta and the genetic risk profile.
| S-EPMC3290383 | biostudies-literature
Project description:ObjectivesTo evaluate the feasibility of dose-modulated retrospective ECG-gated thoracoabdominal aorta CT angiography (CTA) assessing abdominal aortic intimal flap motion and investigate the motion characteristics of intimal flap in acute aortic dissection (AAD).Materials and methods49 patients who had thoracoabdominal aorta retrospective ECG-gated CTA scan were enrolled. 20 datasets were reconstructed in 5% steps between 0 and 95% of the R-R interval in each case. The aortic intimal flap motion was assessed by measuring the short axis diameters of the true lumen and false lumen 2 cm above of celiac trunk ostium in different R-R intervals. Intimal flap motion and configuration was assessed by two independent observers.ResultsIn these 49 patients, 37 had AAD, 7 had intramural hematoma, and 5 had negative result for acute aortic disorder. 620 datasets of 31 patients who showed double lumens in abdominal aorta were enrolled in evaluating intimal flap motion. The maximum and minimum true lumen diameter were 12.2 ± 4.1 mm (range 2.6 ? 17.4) and 6.7 ± 4.1 mm (range 0 ? 15.3) respectively. The range of intimal flap motion in all patients was 5.5 ± 2.6 mm (range 1.8 ? 10.2). The extent of maximum true lumen diameter decreased during a cardiac cycle was 49.5% ± 23.5% (range 12% ? 100%). The maximum motion phase of true lumen diameter was in systolic phase (5% ? 40% of R-R interval). Maximum and minimum intimal flap motion was at 15% and 75% of the R-R interval respectively. Intimal flap configuration had correlation with the phase of cardiac cycle.ConclusionsAbdominal intimal flap position and configuration varied greatly during a cardiac cycle. Retrospective ECG-gated thoracoabdominal aorta CTA can reflect the actual status of the true lumen and provide more information about true lumen collapse. This information may be helpful to diagnosis and differential diagnosis of dynamic abstraction.
| S-EPMC3913653 | biostudies-literature
Project description: Not available
| S-EPMC8343440 | biostudies-literature
Project description:Bicuspid aortic valve (BAV) is associated with asymmetric dilatation of the proximal ascending aorta. We previously demonstrated increased susceptibility of smooth muscle cells to oxidative stress in the BAV-aneurysmal aorta and hypothesized that antioxidant expression is regionally defined and influenced by the BAV morphotype.BAV valve morphology was defined according to number of raphes: type 0 (0 raphes), type 1 (1 raphe), or type 2 (2 raphes) and by the raphe location among the left (L), right (R) or non (N) coronary cusps. Ascending aortic specimens were partitioned into three regions corresponding to the sinuses of Valsalva, denoted R, N (greater curve), and L (lesser curve). Transcripts 1, 2, and 3 from the gene expressing superoxide dismutase (Sod) were quantified in all three regions. Results were compared with aneurysmal and nonaneurysmal aortic specimens from patients with a tricuspid aortic valve.Region-specific Sod1 upregulation and Sod2 downregulation were dependent on the BAV morphotype. Sod3 was uniformly downregulated in all regions in a morphotype-independent manner. Sod1 upregulation was noted in the R region of the nonaneurysmal type 1 L/R morphotype. Aortic valve regurgitation, but not stenosis, affected the expression of Sod isoforms in specimens of degenerative aneurysms.Region-specific transcription profiles of Sod on the basis of BAV morphotype deepen our understanding of its associated aortopathy and provide biological insight on the asymmetric dilatation pattern. This work indicates regional differences exist in the oxidative stress biology of the proximal aortic wall, and this may lead to newer diagnostic techniques to adjudicate aortic catastrophe risk.
| S-EPMC6003236 | biostudies-literature
Project description:BackgroundAscending aortic aneurysms constitute an important hazard for individuals with a bicuspid aortic valve (BAV). However, the processes that degrade the aortic wall in BAV disease remain poorly understood.MethodsWe undertook in situ analysis of ascending aortas from 68 patients, seeking potentially damaging cellular senescence cascades. Aortas were assessed for senescence-associated-ß-galactosidase activity, p16Ink4a and p21 expression, and double-strand DNA breaks. The senescence-associated secretory phenotype (SASP) of cultured-aged BAV aortic smooth muscle cells (SMCs) was evaluated by transcript profiling and consequences probed by combined immunofluorescence and circular polarization microscopy. The contribution of p38 MAPK signaling was assessed by immunostaining and blocking strategies.FindingsWe uncovered SMCs at varying depths of cellular senescence within BAV- and tricuspid aortic valve (TAV)-associated aortic aneurysms. Senescent SMCs were also abundant in non-aneurysmal BAV aortas but not in non-aneurysmal TAV aortas. Multivariable analysis revealed that BAV disease independently associated with SMC senescence. Furthermore, SMC senescence was heightened at the convexity of aortas associated with right-left coronary cusp fusion. Aged BAV SMCs had a pronounced collagenolytic SASP. Moreover, senescent SMCs in the aortic wall were enriched with surface-localized MMP1 and surrounded by weakly birefringent collagen fibrils. The senescent-collagenolytic SMC phenotype depended on p38 MAPK signaling, which was chronically activated in BAV aortas.InterpretationWe have identified a cellular senescence-collagen destruction axis in at-risk ascending aortas. This novel "seno-destructive" SMC phenotype could open new opportunities for managing BAV aortopathy. FUND: Canadian Institutes of Health Research, Lawson Health Research Institute, Heart and Stroke Foundation of Ontario/Barnett-Ivey Chair.
| S-EPMC6562112 | biostudies-literature
Project description:OBJECTIVES:Bicuspid aortic valve (BAV) is the most common congenital valvular abnormality and frequently presents with accelerated calcific aortic valve disease, requiring aortic valve replacement (AVR) and thoracic aortic aneurysm and dissection. Supporting evidence for Association Guidelines of aortic dimensions for aortic resection is sparse. We sought to determine whether concurrent repair of dilated or aneurysmal aortic disease during AVR in patients with BAV substantially improves morbidity and mortality outcomes. METHODS:Mortality and reoperation outcomes of 1301 adults with BAV and dilated aorta undergoing AVR-only surgery were compared to patients undergoing AVR with aortic resection (AVR-AR) using Cox proportional hazards modelling and patient matching. RESULTS:Clinically important differences in patient characteristics, aortic valve function and aortic dimensions were identified between cohorts. Event rates were low, with rates of reoperation and death within 1 year of only 1.8% and 5.4%, respectively, and no aortic dissection observed during follow-up. There were no significant differences in reoperation or mortality outcomes between the AVR-only and AVR-AR cohorts. Age, aortic dimension or a combination thereof was not associated with better or worse outcomes after each AVR-AR compared with AVR. CONCLUSIONS:We conclude AVR-only and AVR-AR surgery have low morbidity and mortality and have utility over a wide range of age and aortic sizes. Our results do not provide support for the 45-mm aortic dimension recommended in the current guidelines for aortic resection while performing AVR or any other specific dimension.
| S-EPMC6018902 | biostudies-other