OBJECTIVES: We aimed to identify a phenotype of ascending thoracic aortic aneurysm (TAA), which, more than others, evolves into type A dissection (TAD). METHODS: Aortic specimens were obtained from patients undergoing surgical repair of TAA and TAD (108 and 26, respectively). Histopathological and immunohistochemical analyses were performed by using adequate tissue specimens, appropriate techniques and criteria. RESULTS: We identified the three following TAA phenotypes: phenotype I (cystic medial degeneration balanced by a substitutive fibrosis, in absence of medial apoptosis and with a faint collagenase concentration), phenotype II (cystic medial degeneration of higher grade, respectively, than substitutive fibrosis, with focal medial apoptosis and moderate collagenase concentration), and phenotype III (elevated cystic medial degeneration without substitutive fibrosis, with plurifocal medial apoptosis and severe collagenase concentration). The same medial degenerative lesions of TAA phenotype III were observed in TAD tissue samples. CONCLUSIONS: The morphological identity of medial lesions observed in both the TAA phenotype III and in TAD aortas might be assumed to be the precursor-and consequently the optimal biomarker- of dissection, independently of aneurysm diameter or valvular disorder. Identification of genetic risk factors, useful both in diagnostics and in developing more targeted treatment for individual patients, might also be needed.
OBJECTIVES: We aimed to identify a phenotype of ascending thoracic aortic aneurysm (TAA), which, more than others, evolves into type A dissection (TAD). METHODS: Aortic specimens were obtained from patients undergoing surgical repair of TAA and TAD (108 and 26, respectively). Histopathological and immunohistochemical analyses were performed by using adequate tissue specimens, appropriate techniques and criteria. RESULTS: We identified the three following TAA phenotypes: phenotype I (cystic medial degeneration balanced by a substitutive fibrosis, in absence of medial apoptosis and with a faint collagenase concentration), phenotype II (cystic medial degeneration of higher grade, respectively, than substitutive fibrosis, with focal medial apoptosis and moderate collagenase concentration), and phenotype III (elevated cystic medial degeneration without substitutive fibrosis, with plurifocal medial apoptosis and severe collagenase concentration). The same medial degenerative lesions of TAA phenotype III were observed in TAD tissue samples. CONCLUSIONS: The morphological identity of medial lesions observed in both the TAA phenotype III and in TAD aortas might be assumed to be the precursor-and consequently the optimal biomarker- of dissection, independently of aneurysm diameter or valvular disorder. Identification of genetic risk factors, useful both in diagnostics and in developing more targeted treatment for individual patients, might also be needed.
Authors: William Clifford Roberts; Travis James Vowels; Benjamin Lee Kitchens; Jong Mi Ko; Giovanni Filardo; Albert Carl Henry; Baron Lloyd Hamman; Gregory John Matter; Robert Frederick Hebeler Journal: Am J Cardiol Date: 2011-12-01 Impact factor: 2.778
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Authors: Jeffrey A Jones; Robert E Stroud; Elizabeth C O'Quinn; Laurel E Black; Jeremy L Barth; John A Elefteriades; Joseph E Bavaria; Joseph H Gorman; Robert C Gorman; Francis G Spinale; John S Ikonomidis Journal: Circ Cardiovasc Genet Date: 2011-10-18
Authors: Mari Levula; Timo Paavonen; Timo Valo; Markku Pelto-Huikko; Reijo Laaksonen; Mika Kahonen; Ari Huovila; Terho Lehtimaki; Matti Tarkka; Ari A Mennander Journal: Scand J Clin Lab Invest Date: 2011-07-06 Impact factor: 1.713
Authors: Derek P Nathan; Chun Xu; Joseph H Gorman; Ron M Fairman; Joseph E Bavaria; Robert C Gorman; Krishnan B Chandran; Benjamin M Jackson Journal: Ann Thorac Surg Date: 2011-02 Impact factor: 4.330
Authors: Rajendra H Mehta; Toru Suzuki; Peter G Hagan; Eduardo Bossone; Dan Gilon; Alfredo Llovet; Luis C Maroto; Jeanna V Cooper; Dean E Smith; William F Armstrong; Christoph A Nienaber; Kim A Eagle Journal: Circulation Date: 2002-01-15 Impact factor: 29.690