Regional and Directional Delamination Properties of Healthy Human Ascending Aorta and Sinotubular Junction

2021 ◽  
Author(s):  
Yue Xuan ◽  
Zhongjie Wang ◽  
Julius M. Guccione ◽  
Elaine Tseng ◽  
Liang Ge
Keyword(s):  
Ascending Aorta ◽  
Healthy Human ◽  
Sinotubular Junction

Early safety performance of a modified technique of aorta replacement with sinotubular stabilization

2021 ◽  
pp. 021849232110150
Author(s):  
Marco Moscarelli ◽  
Nicola Di Bari ◽  
Giuseppe Nasso ◽  
Khalil Fattouch ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Safety Performance ◽  
Modified Technique ◽  
Sinotubular Junction ◽  
Aorta Replacement ◽  
Valve Sparing ◽  
Ascending Aorta Replacement

Background We sought to determine if a modified technique for ascending aorta replacement with sinotubular junction reduction and stabilization was safe. Methods This technique was performed by suspension of the three commissures, invagination of the aortic Dacron graft and advancing the graft into the ventricles. We included patients with dilatation of the ascending aorta, normal sinuses of Valsalva dimension (<45 mm), with or without aortic annulus enlargement (>25 mm) and with various degree of aortic insufficiency (from grade 1 to 3). Results From April to October 2019, 20 patients were recruited from two centers; mean age was 66.9 ± 12.8 years, 13 were male; grade 1, 2 and 3 was present in 12, 2 and 6 patients, respectively. All patients underwent ascending aorta replacement with modified technique; an additional open subvalvular ring was used in 8 patients with aortic insufficiency ≥ 2; cusps repair was performed in 6 patients (5 plicating central stitches/1 shaving); concomitant coronary artery bypass grafting was performed in 10 patients. There was no 30-day mortality. One patient was re-explored for bleeding. All patients completed six-month follow-up; at the transthoracic echocardiography, there was no aortic insufficiency ≥ 1 except one patient with aortic insufficiency grade 1 who underwent ascending aorta replacement and subvalvular ring; no patients underwent reintervention. Conclusions This modified technique for ascending aorta replacement and sinotubular junction stabilization was safe. It could be associated with other aortic valve sparing techniques. However, such remodeling approach has to be validated in a larger cohort of patients with longer follow-up.

scholarly journals Papillary Fibroelastoma of the Ascending Aorta

2019 ◽  
Vol 7 ◽  
pp. 232470961984037
Author(s):  
Karim M. Al-Azizi ◽  
Mohanad Hamandi ◽  
Ronald Baxter ◽  
Anita Krueger ◽  
Alexander W. Crawford ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ascending Aorta ◽  
Embolic Stroke ◽  
Papillary Fibroelastoma ◽  
Cardiac Tumors ◽  
Unusual Site ◽  
Sinotubular Junction ◽  
Primary Cardiac Tumors

Papillary fibroelastomas are rare benign primary cardiac tumors. They are typically found on valvular surfaces, most commonly, the aortic valve. In this article, we report a case of papillary fibroelastoma arising from the sinotubular junction of the ascending aorta, a rare and unusual site causing an embolic stroke.

scholarly journals Increased aortic root diameters in patients with acromegaly

2008 ◽  
Vol 159 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Agatha A van der Klaauw ◽  
Jeroen J Bax ◽  
Johannes W A Smit ◽  
Eduard R Holman ◽  
Victoria Delgado ◽  
...  
Keyword(s):  
Aortic Root ◽  
Clinical Manifestations ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Inactive Disease ◽  
Valvular Regurgitation ◽  
Healthy Controls ◽  
Aortic Sinus ◽  
Sinotubular Junction

ObjectiveThe clinical manifestations of acromegalic cardiomyopathy include arrhythmias, valvular regurgitation, concentric left ventricular (LV) hypertrophy, and LV systolic and diastolic dysfunction. At present, it is unknown whether acromegaly also affects the aortic root.DesignAortic root diameters were prospectively assessed in 37 acromegalic patients (18 patients with active disease and 19 with controlled disease) by conventional two-dimensional and Doppler echocardiography before, and after, an observation period of 1.9 years (range 1.5–3.0 years). Baseline parameters were compared with healthy controls.ResultsThe diameters of the aortic root at the sino-tubular junction and the ascending aorta were increased in patients with acromegaly: 30±4 vs 26±3 mm (P=0.0001) and 33±5 vs 30±4 mm (P=0.006) respectively. The diameter of the aortic root at the aortic annulus and aortic sinus were not different from controls. During follow-up, the aortic root diameters increased at the levels of the annulus and the sinotubular junction (P=0.025 and P=0.024 respectively), whereas there was no change in the diameters at the levels of the sinus and the ascending aorta during follow-up. Baseline aortic root diameters were not influenced by disease duration, current disease activity, or blood pressure. When patients with active and inactive disease were analyzed separately, only the diameter of the sinotubular junction increased in patients with inactive acromegaly during follow-up (P=0.031).ConclusionAortic root diameters are increased in patients with acromegaly compared with healthy controls.

scholarly journals Surgical approach of bentall procedure in a patient of pectus excavatum

2017 ◽  
Vol 5 (11) ◽  
pp. 5069
Author(s):  
Subrata Pramanik ◽  
Ajit Padhy ◽  
Nayem Raja ◽  
Subodh Satyarthy
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Bypass ◽  
Pectus Excavatum ◽  
Ascending Aorta ◽  
Sinotubular Junction ◽  
Descending Aorta ◽  
X Ray ◽  
Severe Aortic Regurgitation ◽  
Bentall Procedure ◽  
Chest X Ray

A middle-aged man diagnosed case of Marfan syndrome associated with pectus excavatum presented with chest pain and dyspnea. Chest X-ray, transthoracic echocardiography and Computed tomography (CT) of heart and aorta revealed severe Aortic regurgitation with dilated aortic root, sinotubular junction and ascending aorta with normal size arch and descending aorta. Patient was taken for surgery. Pectus excavatum creates difficulties for heart exposure and cannulation for cardiopulmonary bypass. We planned for femoro-femoral bypass to carry out ahesiolysis and Bentall procedure without much difficulties. Postoperative stay of the patient was uneventful and followed up in regular interval.

Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm

2017 ◽  
Vol 24 (2) ◽  
pp. 281-289 ◽  
Author(s):  
Foeke J. H. Nauta ◽  
Guido H. W. van Bogerijen ◽  
Chiara Trentin ◽  
Michele Conti ◽  
Ferdinando Auricchio ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Celiac Trunk ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Sinotubular Junction ◽  
Aortic Repair ◽  
Brachiocephalic Trunk ◽  
The Impact ◽  
Longitudinal Strains

Purpose: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications. Methods: This retrospective study assessed the impact of TEVAR on pulsatile aortic strains through custom developed software and cardiac-gated computed tomography imaging of 8 thoracic aneurysm patients (mean age 71.0±8.2 years; 6 men) performed before TEVAR and during follow-up (median 0.1 months, interquartile range 0.1–5.8). Lengths of the ascending aorta, the aortic arch, and the descending aorta were measured. Diameters and areas were computed at the sinotubular junction, brachiocephalic trunk, left subclavian artery, and the celiac trunk. Pulsatile longitudinal and circumferential strains were quantified as systolic increments of length and circumference divided by the corresponding diastolic values. Results: Average pulsatile longitudinal strain ranged from 1.4% to 7.1%, was highest in the arch (p<0.001), and increased after TEVAR by 77% in the arch (7.1%±2.5% vs 12.5%±5.1%, p=0.04) and by 69% in the ascending aorta (5.6±2.3% vs 9.4±4.4%, p=0.06). Average pulsatile circumferential strain ranged from 3.6% to 5.0% before TEVAR and did not differ significantly throughout the thoracic aorta; there was a nonsignificant increase after TEVAR at the unstented sinotubular junction (5.0%±1.4% vs 6.3%±1.0%, p=0.18), with a significant increase at the celiac trunk (3.6%±1.8% vs 6.2%±1.8%, p=0.02). Pulsatile circumferential strains within stented segments were deemed unreliable due to image artifacts. Conclusion: TEVAR was associated with an increase of pulsatile longitudinal strains (in the arch) and circumferential strains (at the celiac trunk) in unstented aortic segments. These observations suggest increased pulsatile wall stress after TEVAR in segments adjacent to the device, which may contribute to the understanding of stent-graft–related complications such as retrograde dissection, aneurysm formation, and rupture.

scholarly journals Isolated aortic insufficiency valve repair with external ring annuloplasty: a standardized approach

2019 ◽  
Author(s):  
Mustafa Zakkar ◽  
Vito D Bruno ◽  
Pavel Zacek ◽  
Isabelle Di Centa ◽  
Christophe Acar ◽  
...  
Keyword(s):  
Survival Rate ◽  
Aortic Valve ◽  
General Population ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Sinotubular Junction ◽  
External Ring ◽  
Double Ring ◽  
Ring Annuloplasty ◽  
Single Ring

Abstract OBJECTIVES Aortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty). METHODS Single centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair. RESULTS The overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007). CONCLUSIONS Standardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.

Partial Aortic Root Remodeling in Case of Ascending Aortic Aneurysms

2013 ◽  
Vol 8 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Fabrizio Sansone ◽  
Edoardo Zingarelli ◽  
Fabrizio Ceresa ◽  
Francesco Patanè
Keyword(s):  
Aortic Root ◽  
Pathological Process ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Bleeding Complications ◽  
Sinotubular Junction ◽  
Computed Tomographic ◽  
Aortic Root Remodeling ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Objective In degenerative ascending aortic aneurysms (AAAs), the pathological process may extend into the aortic root, causing aortic regurgitation (AR). As often one or two sinuses are involved, ascending aorta replacement should be associated with selected sinus replacement. Methods Thirty patients (21 men and 9 women; mean ± SD age, 70.0 ± 10.4) were operated on for ascending aorta and selected sinus replacement. All patients had degenerative AAA with sinotubular junction and partial root dilatation: one or two sinuses of Valsalva were involved. Mild to moderate-severe AR was present in all patients. The mean ± SD logistic EUROscore 1 was 15.4 ± 12.5. Twenty patients had ascending aorta replacement associated with noncoronary sinus replacement; 8 patients, associated with both right and noncoronary sinuses; 1 patient, associated with both left and noncoronary sinuses; and 1 patient, associated with left coronary sinus alone. Results There were no hospital or late deaths. No thromboembolic event or bleeding complications were reported. Postoperative echocardiography did not show significant AR, and computed tomographic scanning revealed a normal positioning of the vascular graft in the ascending aorta. Conclusions Remodeling of the sinotubular junction with selected sinus replacement in degenerative AAA is a valuable approach for aortic root remodeling, leading to a significant reduction of AR when the aortic leaflets are normal.

scholarly journals Ectopic High Origin of a Coronary Artery from the Aorta – A Possible Cause of Sudden Death

2009 ◽  
Vol 52 (4) ◽  
pp. 171-172
Author(s):  
Bülent Eren ◽  
Nursel Türkmen ◽  
Berna Senel
Keyword(s):  
Coronary Artery ◽  
Sudden Death ◽  
Left Coronary Artery ◽  
Ascending Aorta ◽  
Marmara Sea ◽  
Normal Position ◽  
Left Wall ◽  
Sinotubular Junction ◽  
The Right ◽  
Possible Cause

Congenital anomalies originating it the coronary arteries are of special interest for forensic specialists. The presented case is a man found dead on the Coast of Marmara Sea. The death was considered to be suspicious and an autopsy was performed. On the macroscopic autopsy, the ostium of the right coronary artery was hole-like, located in a normal position, but the ostium of the left coronary artery was pocket-shaped and located in the left wall of the ascending aorta and above the rim of the sinotubular junction. We describe an asymptomatic, but didactic case with ectopic high origin of the left coronary artery.

Repair of idiopathic ascending aortic aneurysm in a 7-year-old child

2014 ◽  
Vol 25 (1) ◽  
pp. 154-157 ◽  
Author(s):  
Baskar R. Karthekeyan ◽  
Mahesh Vakamudi ◽  
Periyasamy Thangavel
Keyword(s):  
Aortic Aneurysm ◽  
Genetic Mapping ◽  
Thoracic Aortic Aneurysm ◽  
Paediatric Population ◽  
Ascending Aorta ◽  
Ascending Aortic Aneurysm ◽  
Sinotubular Junction ◽  
Natural Progression

AbstractAscending aortic aneurysm is uncommon in the paediatric population, and because of the rarity the aetiology, natural progression, and prognosis of the disease remain unknown. A 7-year-old boy with ascending thoracic aortic aneurysm (60×67 mm) underwent graft anastomosis from the sinotubular junction to the undersurface of the arch. Analytical determinations including karyotyping and genetic mapping were all normal. To our knowledge, idiopathic aneurysm of the ascending aorta in children is very rare.

scholarly journals Ascending Aortic Wall Cohesion: Comparison of Bicuspid and Tricuspid Valves

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Jaroslav Benedik ◽  
Kevin Pilarczyk ◽  
Daniel Wendt ◽  
Jiri Indruch ◽  
Radek Flek ◽  
...  
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Sinotubular Junction ◽  
Custom Made ◽  
Wall Specimen ◽  
Av Malformation ◽  
Group 2 ◽  
Group 1

Objectives. Bicuspid aortic valve (AV) represents the most common form of congenital AV malformation, which is frequently associated with pathologies of the ascending aorta. We compared the mechanical properties of the aortic wall between patients with bicuspid and tricuspid AV using a new custom-made device mimicking transversal aortic wall shear stress.Methods. Between 03/2010 and 07/2011, 190 consecutive patients undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with a bicuspid (group 1,n=44) or a tricuspid (group 2,n=146) AV. Aortic wall specimen were examined with the “dissectometer” resulting in nine specific aortic-wall parameters derived from tensile strength curves (TSC).Results. Patients with a bicuspid AV showed significantly more calcified valves (43.2% versus 15.8%,P<0.001), and a significantly thinner aortic wall (2.04±0.42 mm versus2.24±0.41 mm,P=0.008). Transesophageal echocardiography diameters (annulus, aortic sinuses, and sinotubular junction) were significantly larger in the bicuspid group (P=0.003,P=0.02,P=0.01). We found no difference in the aortic wall cohesion between both groups as revealed by shear stress testing (P=0.72,P=0.40,P=0.41).Conclusion. We observed no differences of TSC in patients presenting with tricuspid or bicuspid AVs. These results may allow us to assume that the morphology of the AV and the pathology of the ascending aorta are independent.

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