OBJECTIVES: Recently, increased length of the ascending aorta has been suggested as a possible risk factor for acute type A aortic dissection (ATAAD). Our goal was to identify measurable aortic geometrical characteristics associated with elongation that could differentiate ATAAD from uncomplicated aortic dilation (>45mm).METHODS: In angiographic computed tomography scans performed in 180 patients having cardiac surgery, aortic diameters, root length, length of the ascending aorta at both the centreline and the greater curvature (convexity) and the root-ascending (root-asc) angle (that between the root axis and the axis of the ascending tract) and the ascending-arch (asc-arch) angle (that between the axis of the ascending aorta and the arch axis) were measured and compared among 3 patient groups: normal aorta (diameter < 45mm), dilation/aneurysm (>45mm) and ATAAD. Correlations between diameters and angles, diameters and lengths and lengths and angles were analysed; multivariable analysis including geometrical factors was performed to identify independent predictors of ATAAD.RESULTS: Both patients with aneurysms and patients with ATAAD showed significantly elongated ascending aortas (P<0.001 vs normal). However, in the aneurysms, the root-asc angle (136 degrees 20 degrees vs 147 degrees +/- 17 degrees; P<0.001) and in ATAAD the asc-arch angle were uniquely narrower than that in the normal aorta (116 degrees +/- 11 degrees vs 132 degrees +/- 19 degrees; P<0.001). All patients with an ATAAD had an asc-arch angle <= 130 degrees. Both in patients with ATAAD and in those without ATAAD, narrowing of the asc-arch angle was associated with elongation of the root segment (P<0.001). In multivariable analysis, the asc-arch angle and the total length of the ascending aorta (root+tubular) were significant predictors of ATAAD.CONCLUSIONS: The asc-arch angle is a promising measurement that could help predict aortic dissection along with aortic diameter and length: further verification is warranted.

Implications of abnormal ascending aorta geometry for risk prediction of acute type A aortic dissection

Rubino, Antonino Salvatore
Writing – Review & Editing
;
2021-01-01

Abstract

OBJECTIVES: Recently, increased length of the ascending aorta has been suggested as a possible risk factor for acute type A aortic dissection (ATAAD). Our goal was to identify measurable aortic geometrical characteristics associated with elongation that could differentiate ATAAD from uncomplicated aortic dilation (>45mm).METHODS: In angiographic computed tomography scans performed in 180 patients having cardiac surgery, aortic diameters, root length, length of the ascending aorta at both the centreline and the greater curvature (convexity) and the root-ascending (root-asc) angle (that between the root axis and the axis of the ascending tract) and the ascending-arch (asc-arch) angle (that between the axis of the ascending aorta and the arch axis) were measured and compared among 3 patient groups: normal aorta (diameter < 45mm), dilation/aneurysm (>45mm) and ATAAD. Correlations between diameters and angles, diameters and lengths and lengths and angles were analysed; multivariable analysis including geometrical factors was performed to identify independent predictors of ATAAD.RESULTS: Both patients with aneurysms and patients with ATAAD showed significantly elongated ascending aortas (P<0.001 vs normal). However, in the aneurysms, the root-asc angle (136 degrees 20 degrees vs 147 degrees +/- 17 degrees; P<0.001) and in ATAAD the asc-arch angle were uniquely narrower than that in the normal aorta (116 degrees +/- 11 degrees vs 132 degrees +/- 19 degrees; P<0.001). All patients with an ATAAD had an asc-arch angle <= 130 degrees. Both in patients with ATAAD and in those without ATAAD, narrowing of the asc-arch angle was associated with elongation of the root segment (P<0.001). In multivariable analysis, the asc-arch angle and the total length of the ascending aorta (root+tubular) were significant predictors of ATAAD.CONCLUSIONS: The asc-arch angle is a promising measurement that could help predict aortic dissection along with aortic diameter and length: further verification is warranted.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11387/171485
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