- 作者：Bartosz Rylski ; MD&lowast ; ; &dagger ; ; bartosz.rylski@universitaets-herzzentrum.de" class="auth_mail ; Philipp Blanke ; MD&Dagger ; ; Friedhelm Beyersdorf ; MD ; PhD&dagger ; ; Nimesh D. Desai ; MD ; PhD&lowast ; ; Rita K. Milewski ; MD ; PhD&lowast ; ; Matthias Siepe ; MD&dagger ; ; Fabian A. Kari ; MD&dagger ; ; Martin Czerny ; MD§ ; ; Thierry Carrel ; MD§ ; ; Christian Schlensak ; MD鈥?/sup> ; Tobias Krü ; ger ; MD鈥?/sup> ; Michael J. Mack ; MD¶ ; ; William T. Brinkman ; MD¶ ; ; Friedrich W. Mohr ; MD ; PhD# ; Christian D. Etz ; MD ; PhD# ; Maximilian Luehr ; MD# ; Joseph E. Bavaria ; MD&lowast ;
- 关键词：aorta ; computed tomography ; dissection ; surgery
- 刊名：Journal of the American College of Cardiology
- 出版年：8 April, 2014
- 年：2014
- 卷：63
- 期：13
- 页码：1311-1319
- 全文大小：1696 K
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聽patients. Included were all non-Marfan patients with nonbicuspid aortic valves who had undergone computed tomography angiography聽<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;聽77] years; 54% were men). In all but 1 patient, maximum ascending aortic diameter was聽<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,聽+12.8 mm; p聽<聽0.001; 124.0 [90.8; 162.5] cm3 vs. 171.0 [147.0; 197.0] cm3,聽+47 cm3; p聽< 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聽< 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聽<聽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聽pronounced in the ascending aorta. Both spontaneous and retrograde dissection result in similar aortic聽geometry changes.