Ascending aortic elongation and the risk of dissection
Ascending aortic elongation and the risk of dissection
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DOI：
10.1093/ejcts/ezw025
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发表时间：
2016-08-01
影响因子：
3.4
通讯作者：
Schlensak, Christian
中科院分区：
文献类型：
--
作者：
Krueger, Tobias;Forkavets, Oksana;Schlensak, Christian
与动脉瘤形成不同，升主动脉延长在A型主动脉夹层（A型主动脉夹层）发病机制中的作用尚不清楚。我们研究了健康、夹层和夹层前动脉瘤的形态，重点是升主动脉长度。我们回顾性比较了临床和计算机断层扫描血管造影（CTA）数据，包括130例主动脉夹层患者、16例在进一步临床过程中发生主动脉夹层的患者和165例因非主动脉急症接受CTA的健康对照患者。升主动脉的长度定义为窦管连接处（STJ）与头臂干（BCT）在中心线上的距离、内外弯的距离以及在额状面和矢状面上的直线距离。在健康对照组中，年龄与主动脉直径（r = 0.57）和主动脉长度（r = 0.42）呈正相关。各参数与体尺的相关性可忽略不计（r < 0.2）。肺动脉高度处的升主动脉直径中位数（50 mm）显著大于健康人的相应直径（34 mm）（P < 0.001）。与健康对照组相比，前列腺的直径（40 mm）也明显更大。这些比例在所有主动脉直径中相似。正常升支气管中线长度为71mm，术前和术后升支气管中线长度分别为81mm和92mm（P均< 0.001）。我们评价了冠状面中STJ和BCT之间的线性距离，作为一个易于测量的主动脉长度参数。主动脉瘤直径（108 mm）和前主动脉瘤直径（97 mm）明显大于健康主动脉瘤（84 mm），主动脉直径可能不是预测夹层的最佳参数。大多数的动脉瘤在直径小于55 mm时解剖。与健康对照组相比，动脉瘤和前动脉瘤都被拉长。因此，主动脉延长可能在动脉粥样硬化的发病机制中起作用，并且可能是动脉粥样硬化的危险因素。
Unlike aneurysm formation, the role of ascending aortic elongation in the pathogenesis of Type A aortic dissection (TAD) is largely unclear. We investigated the morphology of healthy, dissected and predissection aortas with a focus on ascending aortic length.We retrospectively compared clinical and computer tomography angiography (CTA) data from TAD patients (n = 130), patients who developed a TAD in the further clinical course (preTAD, n = 16) and healthy control patients who received a CTA for non-aortic emergencies (n = 165). The length of the ascending aorta was defined as the distance between the sinotubular junction (STJ) and the brachiocephalic trunk (BCT) at the central line, the outer and inner curvature as well as the direct distance in the frontal and sagittal planes. Additionally, the aortic diameters were analysed.In the healthy controls, we found a positive correlation of age with the aortic diameter (r = 0.57) and aortic length (r = 0.42). The correlation of the respective parameters with the body size was negligible (r < 0.2). The median ascending aortic diameter at the height of the pulmonary artery in TAD (50 mm) was significantly (P < 0.001) larger compared with the respective diameter of the healthy aortas (34 mm). The diameter of the preTAD aortas (40 mm) was also significantly larger compared with the healthy controls. These proportions were similar in all the aortic diameters. The midline length of the healthy ascending aortas was 71 mm. In the preTAD and TAD aortas, the same values were 81 mm and 92 mm, respectively (both P < 0.001). We evaluated the linear distance between the STJ and the BCT in the frontal plane as an easy-to-measure parameter of aortic length. In the TAD aortas (108 mm) and preTAD aortas (97 mm), this distance was significantly longer compared with the healthy aortas (84 mm).Aortic diameter might not be an optimal parameter to predict dissection. Most aortas dissect at diameters below 55 mm. Both the TAD and preTAD aortas were elongated compared with the healthy controls. Thus, aortic elongation may play a role in the pathogenesis of and may be a risk factor for TAD.