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You are here: Contents > 2014 > Volume 23 Number 1 January 2014 > AORTIC VALVE DISEASE > Aortic Wall Thickness: An Independent Risk Factor for Aortic Dissection?

Aortic Wall Thickness: An Independent Risk Factor for Aortic Dissection?

Hadas Shiran1, Justin Odegaard2, Gerald Berry2, D. Craig Miller3, Michael Fischbein3, David Liang1

Departments of 1Cardiovascular Medicine, 2Pathology and 3Cardiothoracic Surgery, Stanford University, California, USA

Background and aim of the study: Aortic aneurysm size is known to portend a higher likelihood of aortic complications in patients with connective tissue disorders (CTD), but other objective tools are needed to determine which patients are at greatest risk of dissection, especially those which reflect the structural integrity and strength of the aortic wall.

Methods: The aortic wall pathology was evaluated in CTD patients with and without acute aortic dissection to identify parameters that affect the risk of dissection. A retrospective review was performed of aneurysm pathology from patients with Marfan syndrome (MFS; n = 53) without dissection undergoing prophylactic aortic root surgery, and acute type A aortic dissection patients (AAAoD; n = 16). Patients without a cardiovascular cause of death (n = 19) served as controls. The minimal aortic medial wall thickness was measured, and medial myxoid degeneration (MMD) and the degree of elastin loss and fragmentation were graded.

Results: The mean minimal aortic wall thickness was 1,625 ± 364 μm in controls, and 703 ± 256 μm and 438 ± 322 μm for MFS and AAAoD patients, respectively. Aortic root diameters did not correlate with aortic wall thickness. A comparison of aortic medial thickness showed that the media was significantly thinner among acute dissection patients than either elective surgical patients (p = 0.02) or controls (p <0.001). Aortic size, degree of MMD, and elastin loss did not vary significantly between CTD patients.

Conclusion: A diminished aortic wall medial thickness may be linked to aortic dissection. High-resolution imaging techniques in the future may lead to the morphological assessment of aortic medial wall thickness in vivo becoming a reality which, in theory, could provide a more refined risk prognostication for acute aortic dissection.

The Journal of Heart Valve Disease 2014;23:17-24

Aortic Wall Thickness: An Independent Risk Factor for Aortic Dissection?

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