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Abstract Background Inflammatory aortic aneurysms represent less than 5% of ascending aortic aneurysms and are mostly diagnosed intraoperatively. Furthermore, to our knowledge, a case of an accompanying inflammatory LAD aneurysm has not been previously reported. Case presentation We report an unusual case of a 42-year-old female with a symptomatic inflammatory aneurysm of the ascending aorta and the LAD. The patient underwent successful resection and replacement of the aneurysm as well as bypass of the LAD. Conclusions The underlying etiology of severe inflammatory ascending aortic aneurysms in a previously healthy individual remains unknown. The pre-operative diagnosis is difficult to obtain as it does not have a characteristic appearance on currently available imaging modalities.

Epicardial adipose tissue (EAT) is an emerging cardiovascular risk factor located between the myocardium and visceral pericardium. In order to investigate the association between EAT and ascending aorta elasticity in patients with type 2 diabetes mellitus (T2DM), we prospectively enrolled a total of 135 T2DM patients and 63 age- and gender-matched non-T2DM controls in this study. They all underwent transthoracic echocardiography to measure EAT thickness and ascending aorta inner diameters which were used to calculate ascending aorta elastic parameters: compliance (C), distensibility (D), strain (S), stiffness index (SI), and Peterson's elastic modulus (EM). We found that the values of C, D, and S were significantly lower, while SI, EM, and EAT thickness were significantly higher in T2DM patients compared with non-T2DM controls. Compared with T2DM patients with EAT < 5 mm group, C, D, and S were significantly reduced, SI and EM were significantly increased in T2DM patients with EAT ≥ 5 mm group (all P <.05). Bivariate correlation and multivariate linear regression analysis revealed that EAT was independently associated with ascending aorta elasticity. Our findings suggest that thickened EAT in patients with T2DM is associated with ascending aorta elasticity, independent of blood glucose. [ABSTRACT FROM AUTHOR]

Background. No clear guidelines exist for performing preventive surgery for ascending aortic (AA) aneurysm in elderly patients. This study aims to provide insights by: (1) evaluating patient and procedural characteristics and (2) comparing early outcomes and long-term mortality after surgery between elderly and non-elderly patients. Methods. A multicenter retrospective observational cohort-study was performed. Data was collected on patients who underwent elective AA surgery in three institutions (2006–2017). Clinical presentation, outcomes, and mortality were compared between elderly (≥70 years) and non-elderly patients. Results. In total, 724 non-elderly and 231 elderly patients were operated upon. Elderly patients had larger aortic diameters (57.0 mm (IQR 53–63) vs. 53.0 mm (IQR 49–58), p < 0.001) and more cardiovascular risk factors at the time of surgery than non-elderly patients. Elderly females had significantly larger aortic diameters than elderly males (59.5 mm (55–65) vs. 56.0 mm (51–60), p < 0.001). Short-term mortality was comparable between elderly and non-elderly patients (3.0% vs. 1.5%, p = 0.16). Five-year survival was 93.9% in non-elderly patients and 81.4% in elderly patients (p < 0.001), which are both lower than that of the age-matched general Dutch population. Conclusion. This study showed that in elderly patients, a higher threshold exists to undergo surgery, especially in elderly females. Despite these differences, short-term outcomes were comparable between 'relatively healthy' elderly and non-elderly patients. [ABSTRACT FROM AUTHOR]

Aim. This study aims to assess the association between levels of biomarkers and postoperative complications in patients after thoracic and thoracoabdominal aortic reconstruction.Material and methods. This study included 132 patients. The most of them underwent ascending aortic and aortic arch reconstruction (65 and 57, respectively).The concentrations of proadrenomedullin, presepsin, procalcitonin, troponin I and N-terminal brain natriuretic peptide were measured before induction anesthesia, at the end of the surgical operation and in 6 hours after surgery.Results. 69 patients had postoperative complications. Among them, inflammatory (27,3%) and cardiovascular complications (12,1%) prevailed. At the end of the surgical operation, the levels of the biomarkers in patients without postoperative complications and with postoperative complications were for presepsin 326 [206; 451] и 620 [332; 829] p459,5 (odds ratio (OR) 6,84, 95% confidence interval (CI): 3,14-14,87) or proadrenomedullin >0,788 (OR 5,47, 95% CI: 1,52-19,68) are associated with the increased risk of postoperative complications. The level of presepsin >519,5 pg/ml at the end of the surgical operation (OR 4,55, 95% CI: 1,97-10,47) is associated with the increased risk of inflammatory complications. Regarding the prognosis of the risk of prolonged cardiotonic drug infusions, threshold values for troponin were >1,04 at the end of the surgical operation (sensitivity 75%, specificity 71,3%, AUC 0,785), >1,57 in 6 hours after surgery (sensitivity 81,3%, specificity 71,6%, AUC 0,794).Conclusion. High levels of presepsin at the end of the surgical operation may be useful to predict the postoperative complications in patients who underwent the aortic surgery however, the low levels of presepsin do not exclude the development of postoperative complications. The increased level of troponin I at the end of the surgical operation and in 6 hours after surgery can be a predictor of the need for cardiotonic support in the postoperative period.

IntroductionThoracic ascending aortic (TAA) aneurysms are an important cause of disability and death and require early detection for effective management. Currently, there is a paucity of data from Africa pertaining to TAA aneurysms. This study describes the spectrum of TAA aneurysms at a peri-urban tertiary hospital.MethodsA descriptive retrospective study based on clinical and echocardiographic imaging data of patients with TAA aneurysms from October 2017–October 2022. Advanced strain imaging was performed to measure left ventricular (LV) basal, apical, and global longitudinal strain as well as circumferential strain (CS) of the ascending aorta as a proxy measurement of aortic compliance.ResultsThe study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50 ± 14.8 years with 45 age and gender matched controls. Most cases (95%) were of African ethnicity. The main etiologies were hypertension (41.7%), HIV (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies (8.6%). Two-thirds of patients (69.7%) presented in heart failure, 10% presented with aortic dissection. Thirty percent of the patients were classified as New York Heart Association (NYHA) class I, 59.7% NYHA II, 8.6% NYHA III and two patients NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P

Background. Majority of patients infected with coronavirus disease 2019 (COVID-19) present with an acute respiratory illness of varying severity. Chest computerized tomography (CT) is one of the important steps in the diagnostic work-up of pulmonary involvement. Cardiovascular complications including pulmonary arterial (PA) abnormalities have been recently emphasized upon. This study aims to evaluate the relationship between severity of pulmonary infection and pulmonary artery/aorta (PA/AA) ratio on chest CT scan. Material and Methods. This cross section study was conducted on 74 patients with confirmed diagnosis of COVID-19 who underwent chest CT scans.. Radiologists assessed every CT examination and graded the extent of pulmonary involvement and severity score obtained. The diameters of PA and aorta were measured and PA/AA ratio was then calculated. Results. Among 74 patients, 28 patients have abnormal PA/AA ration (>1) . Twenty four patients (32.2%) were classified as mild, 39 (52.7%) as moderate and 11 (14.8%) as severe, with statistically significant difference regarding presence of abnormal PA/AA ratio (P> 0.05) specially in patients with severe pulmonary involvement. There was no significant difference regarding gender and age groups. There was no statistically significant relationship between PA/AA ratio and pattern of pulmonary radiological findings. Conclusion. Covid-19 patients with severe pulmonary involvement (higher severity score) tend to have abnormal PA/AA ratio. PA /A ratio could be used as an additional prognostic radiological marker in assessment of Covid-19 infection.

Key Clinical Message: Anomalous origin of right pulmonary artery from the ascending aorta is a rare congenital malformation and it needs surgical management. Consequences of this condition affect lead to pulmonary hypertension and severe pulmonary vascular disease. Anomalous origin of right pulmonary artery from the ascending aorta is a rare congenital heart malformation that results in early infant mortality affecting the right pulmonary artery more than the left. These patients are at risk for the early development of significant pulmonary hypertension. The surgical management during the early period of life is imperative. [ABSTRACT FROM AUTHOR]

Purpose: Ascending aortic pseudoaneurysms are a common phenomenon requiring surgical intervention but can pose high surgical risks in medically complex patients. We report a novel approach to percutaneous closure of ascending aortic pseudoaneurysms using an Amplatzer PFO closure device. Case Report: We present the case of a 65-year-old male with haemoptysis on a background of multiple cardiac surgeries and chronic kidney disease. Serial computerised tomography scans of the thoracic aorta demonstrated an enlarging ascending aortic pseudoaneurysm. Percutaneous closure was considered the safest treatment option. With angiography, the pseudoaneurysm was defined and a 25 mm Amplatzer PFO closure device was deployed. Repeat Computed Tomography aortography performed 43 days later confirmed stable device position and resolution of the pseudoaneurysm. The patient was clinically stable at this follow-up point. Conclusion: The off-label use of the Amplatzer PFO device may provide a viable alternative treatment for ascending aortic pseudoaneurysms in medically complex patients to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch. Materials and methods: Fifteen mongrel dogs underwent surgery. The autologous pericardial patch was sewn on the aortotomy site in the anterior wall of the aortic arch. The animals were followed up for 3 months postoperatively. Computed tomography angiography was used to visualize and measure the aneurysm model. Hematoxylin and eosin staining was used to observe the histological characteristics of the aneurysm model. Changes in aneurysm diameter over time were analyzed using analysis of variance. Results: One dog died of hemorrhage during surgery. Fourteen dogs survived the surgical procedure. Two of them died on the first postoperative day because of ruptures at the suturing margin. The diameter of the aneurysm model was twice as large as that of the aortic arch. There was no significant change in the maximum diameter of the aneurysm model during the follow-up period. Conclusions: We established a controllable and stable aortic arch aneurysm model created with an autologous pericardium patch. The aneurysm model can be used to research endoleaks after thoracic endovascular aortic repair and new endovascular techniques can be applied to the aortic arch.

A 70-year-old woman with a bioprosthetic aortic valve replacement for aortic valve endocarditis complicated by recurrent endocarditis and requiring homograft aortic root replacement 10 years earlier had presented at 1 month after her admission for pseudomonal bacteremia with right-sided chest pain. An aortic pseudoaneurysm, identified on computed tomography, was treated with an ascending aorta thoracic endovascular aortic repair using two overlapping abdominal aortic stent grafts in the ascending aorta. Postoperative and follow-up imaging demonstrated exclusion of the pseudoaneurysm with stable positioning of the stent grafts. Ascending aorta thoracic endovascular aortic repair can be performed safely with good short-term results in patients presenting with infected pseudoaneurysms of the ascending aorta.

This article discusses a rare case of a catastrophic aortic pseudoaneurysm in a 57-year-old man with a history of aortic valve replacement. The patient presented with chest pain and was found to have leukocytosis, increased C-reactive protein, and high sensitivity troponin levels. Imaging tests, including transthoracic echocardiogram and cardiac computed tomography, revealed a multilobed aortic pseudoaneurysm causing severe dilation of the aortic root and ascending aorta. The patient underwent surgery to remove the pseudoaneurysm but unfortunately experienced a cerebrovascular event and died shortly after. The article emphasizes the importance of multimodality imaging for accurate diagnosis and guiding high-risk surgeries. [Extracted from the article]

AimsLittle is known regarding the risk of atherosclerotic cardiovascular disease (ASCVD) conferred by changes in the volume and density of ascending thoracic aorta calcium (ATAC) over time. We evaluated changes in ATAC volume and density scores and incident ASCVD events.Methods and resultsThe Multi-Ethnic Study of Atherosclerosis is a prospective cohort study of individuals without baseline clinical ASCVD. Ascending thoracic aorta calcium was measured from baseline and follow-up (mean interval 2.4 years) cardiac computed tomography (CT). Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) per standard deviation for events after the follow-up exam adjusted for ASCVD risk factors, baseline ATAC and coronary artery calcium (CAC) volume and density, and changes in CAC volume and density. Among 5887 participants, 296 (5.0%) had detectable ATAC at baseline, follow-up, or both exams. A total of 403 events occurred over 9.5 years. An increase in ATAC volume was associated with coronary heart disease (CHD) (HR 1.90, 95% CI 1.14-3.16), ASCVD (HR 1.93, 95% CI 1.26-2.94), and ischaemic stroke (HR 2.14, CI 1.21-3.78). An increase in ATAC density was inversely associated with CHD (HR 0.29, 95% CI 0.14-0.60) and ASCVD (HR 0.42, 95% CI 0.23-0.76), but not stroke (HR 0.61, CI 0.23-1.61).ConclusionAscending thoracic aorta calcium is uncommon on serial cardiac CT. However, changes in ATAC volume and density are both associated with incident ASCVD events, but in opposite directions. Serial assessments in those with baseline ATAC may provide insight into an individual's trajectory of ASCVD risk.

Aorto-cutaneous fistulas are an unusual and life-threatening complication after aortic surgery. We present the case of an endovascular intervention for an aorto-cutaneous fistula of the ascending aorta that was intended to be a bridge to definitive surgical treatment and report a literature review. A 56-year-old woman had a previous Bentall’s procedure and mitral valve annuloplasty in 2016. Four years later she re-presented with an infective pseudoaneurysm of the distal anastomosis of the ascending aortic graft, with aorto-cutaneous fistulation. She was at high risk for a revision operation and required optimization before a major open surgery. A thoracic endovascular aortic repair stent graft (Valiant Navion; Medtronic Inc) was implanted to exclude the distal anastomotic pseudoaneurysm. Two months later she re-presented with a new infected pseudoaneurysm at the proximal end of the previously implanted stent graft, and a further thoracic endovascular aortic repair was undertaken.

Background: KIF6 (kinesin family member 6), a protein coded by the KIF6 gene, serves an important intracellular function to transport organelles along microtubules. In a pilot study, we found that a common KIF6 Trp719Arg variant increased the propensity of thoracic aortic aneurysms (TAA) to suffer dissection (AD). The present study aims for a definite investigation of the predictive ability of KIF6 719Arg vis à vis AD. Confirmatory findings would enhance natural history prediction in TAA. Methods: 1108 subjects (899 aneurysm and 209 dissection patients) had KIF6 719Arg variant status determined. Results: The 719Arg variant in the KIF6 gene correlated strongly with occurrence of AD. Specifically, KIF6 719Arg positivity (homozygous or heterozygous) was substantially more common in dissectors (69.8%) than non-dissectors (58.5%) (p = 0.003). Odds ratios (OR) for suffering aortic dissection ranged from 1.77 to 1.94 for Arg carriers in various dissection categories. These high OR associations were noted for both ascending and descending aneurysms and for homozygous and heterozygous Arg variant patients. The rate of aortic dissection over time was significantly higher for carriers of the Arg allele (p = 0.004). Additionally, Arg allele carriers were more likely to reach the combined endpoint of dissection or death (p = 0.03). Conclusions: We demonstrate the marked adverse impact of the 719Arg variant of the KIF6 gene on the likelihood that a TAA patient will suffer aortic dissection. Clinical assessment of the variant status of this molecularly important gene may provide a valuable "non-size" criterion to enhance surgical decision making above and beyond the currently used metric of aortic size (diameter). [ABSTRACT FROM AUTHOR]

A method of guiding an intermediate catheter from a new alpha-type guiding catheter placed in the ascending aorta to the carotid artery is evaluated in neuroendovascular treatment in challenging anatomic directions of the guiding catheter, such as the bovine aortic arch and type III aortic arch. The existing 8-Fr guiding catheter was given a strong bending shape at the tip to make it an alpha type. The total length of the catheter was 85 cm. This guiding catheter was inserted into the ascending aorta to verify whether a 6-Fr intermediate or aspiration catheter could be coaxially guided into the right and left internal carotid arteries. A silicone vascular model was used for evaluation and in actual clinical cases. Creating an alpha shape of the catheter at the aortic arch was very easy. The inner catheter could be easily guided from the brachiocephalic artery to the right common carotid artery by pushing the alpha shape guiding catheter toward the aortic valve. The catheter was easily guided into the left common carotid artery when the α-guide was pulled a little bit backward. The 0.071-inch lumen aspiration catheter reached the bilateral middle cerebral arteries. The 8-Fr alpha shape guiding catheter quickly guides the inner catheter into the bovine and the type III aortic arch by looking up from the ascending aorta. [ABSTRACT FROM AUTHOR]

An ascending aortic pseudoaneurysm is a potentially lethal complication in aortic procedures. We present a hybrid approach using surgical innominate artery access and the endovascular insertion of an abdominal stent-graft extension to successfully treat a zone 0 ascending aortic pseudoaneurysm in a patient with a prior valve-in-valve transcatheter aortic valve implantation. [ABSTRACT FROM AUTHOR]

Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut's modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure. [ABSTRACT FROM AUTHOR]

Background: Clinically insignificant hemolytic anemia is occasionally a complication of prosthetic valve replacement. However, hemolysis related to kinked grafts is a very rare complication after central repair for acute aortic dissection. Case presentation: A 42-year-old man had undergone replacement of the ascending aorta and a root repair for type A aortic dissection 6 months previously. Laboratory data showed mild hemolysis 5 months later, and he began to complain of fatigue on exertion. The serum hemoglobin level reduced to 8.6 g/dL, and lactate dehydrogenase levels increased to 3071 IU/L with gross change in urine color, indicating hemoglobinuria. We diagnosed mechanical hemolytic anemia caused by a kinked graft and planned a repeat operation. The kinked graft was resected and graft-graft anastomosis was performed. Postoperatively, the clinical course was uneventful, and the hemolytic anemia completely resolved. Conclusion: We herein report a case of hemolytic anemia caused by kinking of the graft 6 months after acute aortic dissection repair. The diagnosis was swiftly made, and the patient was successfully managed with redo surgery. [ABSTRACT FROM AUTHOR]

Cellular communication network factor 2 (CCN2/CTGF) has been traditionally described as a downstream mediator of other profibrotic factors including transforming growth factor (TGF)-β and angiotensin II. However, recent evidence from our group demonstrated the direct role of CCN2 in maintaining aortic wall homeostasis and acute and lethal aortic aneurysm development induced by angiotensin II in the absence of CCN2 in mice. In order to translate these findings to humans, we evaluated the potential association between three polymorphisms in the CCN2 gene and the presence of a thoracic aortic aneurysm (TAA). Patients with and without TAA retrospectively selected were genotyped for rs6918698, rs9402373 and rs12526196 polymorphisms related to the CCN2 gene. Multivariable logistic regression models were performed. In our population of 366 patients (69 with TAA), no associations were found between rs6918698 and rs9402373 and TAA. However, the presence of one C allele from rs12526196 was associated with TAA comparing with the TT genotype, independently of risk factors such as sex, age, hypertension, type of valvulopathy and the presence of a bicuspid aortic valve (OR = 3.17; 95% CI = 1.30–7.88; p = 0.011). In conclusion, we demonstrated an association between the C allele of rs12526196 in the CCN2 gene and the presence of TAA. This study extrapolates to humans the relevance of CCN2 in aortic aneurysm observed in mice and postulates, for the first time, a potential protective role to CCN2 in aortic aneurysm pathology. Our results encourage future research to explore new variants in the CCN2 gene that could be predisposed to TAA development. [ABSTRACT FROM AUTHOR]

Background: Severe atherosclerosis of the ascending aorta (SAA) in patients undergoing surgical revascularization by coronary artery bypass grafting (CABG) is becoming an increasing problem as more elderly patients are diagnosed with coronary artery disease. Strokes and other neurologic insults are common complications in this group, with devastating impacts on outcomes and prognoses. Hypothesis: Early detection of the atherosclerotic aorta and the application of a stroke prevention protocol will reduce the risk of stroke in patients with SAA. Methods: In 2012, we adopted a protocol devised to preemptively detect and manage patients suspected of having SAA. From the time of the application of the protocol, we compared the immediate and late outcomes of CABG in SAA in the 8 years preceding the protocol in a "control" group (30 patients) and in the 8 years following the protocol in a "brain" group (69 patients). Results: More patients with SAA were detected after the initiation of the protocol. They had significantly more history of stroke, renal dysfunction, and left main coronary disease. The percutaneous coronary intervention was utilized more after the protocol (26% vs. 7%) and there was far less utilization of replacement of the ascending aorta (12% vs. 37%). Postoperative stroke rates were significantly less after the protocol (2% vs. 18%), with an almost twofold reduction in stroke associated with SAA even after risk adjustment. The composite endpoints of cardiac death, nonfatal myocardial infarction, and stroke were significantly reduced after initiating the protocol at a median of 2.3 years from the time of revascularization. Conclusion: Early detection of SAA and individualized therapeutic strategies for revascularization is effective in reducing athero‐embolic brain injury and are associated with better prognosis. [ABSTRACT FROM AUTHOR]

Ascending aortic replacement is a challenging and complex surgery. The mortality, morbidity, and outcomes depend on the causes of the ascending aortic pathology and the type of operation. The research was conducted utilizing an observational, prospective, and cohort study of patients at a single center with ascending aortic replacement because of aneurysm and dissection. In thehospital, mortality, morbidity, and short-term outcomes were measured. A total of 85 patients participated in this research. 65.9% of the participants were male, while 34.1% were female. Furthermore, thirty-three patients had Stanford type A aortic dissection (STAAD), whereas 52 had ascending aortic aneurysm (ASAA). Early mortality was (21.21% and 1.9%) for STAAD and ASAA, respectively, while the survival rate after one year was (75.8% and 96.15 %) for ascending dissection and aneurysm, respectively. The results of our study show higher early surgical mortality and morbidity and a lower short-term survival rate for STAAD surgery compared with ASAA surgery. [ABSTRACT FROM AUTHOR]

Abstract Background The magnitude of ascending aortic degeneration in patients with bicuspid aortic valves (BAV) is controversial. Methods The aim of this study was to investigate ascending aortic wall degeneration in patients with BAV as compared with tricuspid aortic valves (TAV). The ascending aortic wall of 67 consecutive patients was processed for histology and immunohistochemistry. The extent of surgery and wall degeneration were investigated. Unadjusted survival was evaluated by Kaplan–Meier analysis. Median follow-up for patients with BAV and TAV was 3.8 years (interquartile range [IQR] 3.5–4.1) and 3.7 years (IQR 3.4–3.9), respectively. Results There were 33 patients with BAV and 34 with TAV. Mid-ascending aorta diameter was 54 mm (IQR 50–60). Replacement of the aortic valve, together with an ascending aortic prosthesis, was more frequent in BAV vs TAV patients (24% vs. 3%, P = 0.013). However, medial fibrosis, elastic fiber thinning, incremental medial degeneration and smooth muscle cell nuclei loss were less prominent in BAV vs TAV patients (0.1 ± 0.4 vs. 0.8 ± 1.4, P = 0.016; 0.6 ± 1.4 vs. 1.6 ± 2.0, P = 0.027; 1.7 ± 0.7 vs. 2.2 ± 0.8, P = 0.045 and 2.3 ± 1.5 vs. 3.2 ± 1.3, P = 0.026, respectively). Conclusions Since degeneration of the ascending aortic wall was seldom prominent, histopathology alone may not support the need for surgery of the dilated ascending aorta in BAV patients as compared with TAV patients.

Objective: This study correlates low strain tangential modulus (LTM) and transition zone onset (TZo) stress, biomechanical parameters that occur within the physiological range of stress seen in vivo, with tissue strength and histopathologic changes in aneurysmal ascending aortic tissue. Method: Ascending aortic aneurysm tissue samples were collected from 41 patients undergoing elective resection. Samples were subjected to planar biaxial testing to quantify LTM and TZo. These were then correlated with strength assessed from uniaxial testing and with histopathologic quantification of pathologic derangements in elastin, collagen, and proteoglycan (PG). Results: Decreased LTM and TZo were correlated with reduced strength (P

Objective: In this study we aimed to understand the role of interaction of the Medtronic Evolut R transcatheter aortic valve with the ascending aorta (AA) by evaluating the performance of the valve and the pressure recovery in different AA diameters with the same aortic annulus size. Methods: A 26-mm Medtronic Evolut R valve was tested using a left heart simulator in aortic root models of different AA diameter (D): small (D = 23 mm), medium (D = 28 mm), and large (D = 34 mm) under physiological conditions. Measurements of pressure from upstream to downstream of the valve were performed using a catheter at small intervals to comprehensively assess pressure gradient and pressure recovery. Results: In the small AA, the measured peak and mean pressure gradient at vena contracta were 11.5 ± 0.5 mm Hg and 7.8 ± 0.4 mm Hg, respectively, which was higher (P

Aortic dissection, a serious medical condition characterized by a tear in the aorta's inner layer leading to the establishment of a false channel within the vessel wall, in this report, we present a very rare case of asymptomatic substantial aortic dissection spanning from the ascending aorta to the abdominal aorta. A 36-year-old male with fever and cough was found to have clinical features suggestive of Marfan syndrome. Examination revealed bilateral fine crackles and a diastolic heart murmur. Imaging showed bilateral infiltrates, hyperinflation, and aortic dissection. Echocardiography confirmed severe aortic valve regurgitation and Stanford type A dissection. Despite recommended surgery, the patient opted for medical therapy due to financial constraints, showing stable cardiac anomalies after 6 months. Aortic dissection, a critical cardiovascular emergency, affects mainly the elderly, exacerbated by hypertension, atherosclerosis, and connective tissue disorders. Early detection via CT and biomarkers is crucial. Type A dissections typically require surgical repair, while endovascular repair is used for complex Type B cases, reducing long-term mortality. The TEM system aids in categorization, guiding treatment. Conditions like Marfan syndrome significantly contribute to aortic wall degeneration, requiring close monitoring and intervention. The coalescence of aortic dissections with Marfan syndrome underscores the need for tailored monitoring in high-risk populations and highlights the silent complexities of cardiovascular pathologies, urging refined diagnostics and therapeutic approaches. • This report describes a rare asymptomatic aortic dissection extending from the ascending to the abdominal aorta in a 36-year-old with Marfan syndrome. • The patient's substantial dissection presented without classic symptoms, challenging conventional diagnostic expectations and highlighting a need for enhanced clinical vigilance. • This case challenges the standard approach to diagnosing and managing aortic dissection, advocating for personalized diagnostic strategies in high-risk individuals. • Marfan syndrome, linked to aortic dissection, complicates early detection due to its silent nature in some cases, underscoring the importance of regular monitoring. • The case underscores the critical role of advanced imaging and biomarkers in early detection and management of aortic dissection, especially in atypical presentations. [ABSTRACT FROM AUTHOR]

Minimally invasive techniques have gained immense importance in cardiovascular surgery. While minimal access strategies for coronary and mitral valve surgery are already widely accepted and often used as standard approaches, the application of minimally invasive techniques is currently expanded towards more complex operations of the ascending aorta as well. In this new and developing field, various techniques have been established and reported ranging from upper hemisternotomy approaches, which allow even extensive operations of the ascending aorta to be performed through a minimally invasive access to sternal sparing thoracotomy strategies, which completely avoid sternal trauma during ascending aorta replacements. All of these techniques place high demands on patient selection, preoperative planning, and practical surgical implementation. Application of these strategies is currently limited to high-volume centers and highly experienced surgeons. This narrative review gives an overview of the currently available techniques with a special focus on the practical execution as well as the advantages and disadvantages of the currently available techniques. The first results demonstrate the practicability and safety of minimally invasive techniques for replacement of the ascending aorta in a well-selected patient population. With success and complication rates comparable to classic full sternotomy, the proof of concept for minimally invasive replacement of the ascending aorta is now achieved.

The issue of ascending aortic repair with concomitant aortic valve replacement in pa-tients with ascending aortic aneurysm (AscAA) and aortic valve stenosis is still debatable.Aim. To analyze the dimension changes of the preserved aortic root after simultaneous ascending aorta repair and aortic valve replacement.Material and methods. This retrospective study included 102 patients who, from December 2012 to May 2022, underwent simultaneous aortic valve replacement and ascending aorta repair with hemiarch replacement. Patients were divided into 2 following groups based on the aortic valve morphology: group 1 — patients with bicuspid aortic valve (BAV) and AscAA (n=75), group 2 — patients with tricuspid aortic valve (TAV) and AscAA (n=27). Depending on the presence of aortic root dilatation (maximum diameter (d) >40 mm), each of the groups was additionally stratified into 2 more subgroups as follows: patients without aortic root dilatation (d≤40 mm) and patients with its dilatation (d>40 mm). The dynamics of the aortic root diameter was assessed by computed tomography angiography.Results. The mean follow-up period for patients was 36,2±14,6 months. Survival rate in the BAV+AscAA and TAV+AscAA groups was 96% and 100%, respectively (p=0,380). Freedom from aortic root resurgery was 100% in both study groups. In patients with dilated and non-dilated aortic root of the BAV+AscAA group, an increase in aortic root dimension was noted at a rate of 0,65±0,51 mm/year and 0,32±0,27 mm/year, respectively. In patients of the TAV+AscAA group, a regression in dilated and non-dilated aortic root diameter was observed as follows: 0,93±0,48 mm/year and 0,56±0,43 mm/year, respectively.Conclusion. In patients with AscAA in combination with BAV stenosis after a singlestep surgical intervention, a weak negative dynamics of non-dilated and dilated aortic root is observed in the mid-term follow-up period. In patients with AscAA and TAV, there is involutive alterations of the aortic root dimension during 3-year follow-up.

Large mural thrombi in the relatively normal ascending aorta are extremely uncommon conditions that may lead to major adverse cardiovascular events due to new embolism. Because of their changeable variations, the management of these unstable thrombi is challenging and controversial. The size, morphology, location, embolic involvement, and patients’ conditions are all crucial for therapeutic decision-making. Treatment options include anticoagulation, thrombolysis, surgical thrombectomy, and endovascular stenting. Therefore, surgical strategies should be highly individualized. Herein, we present a rare case of a huge thrombus from the ascending aorta to the arch in a 43-year-old man. Considering the high risks of catastrophic embolic events, surgical removal of the aortic mass, thromboendarterectomy, and reconstruction of the arterial wall were performed with a satisfactory outcome. This report illustrates our experience of surgical strategies and perioperative treatments for this challenging case, and contemporary surgical management for mural thrombi in the ascending aorta was also thoroughly discussed.

ObjectivesAscending aortic aneurysms are associated with pre-existing conditions, including connective tissue disorders (i.e., Marfan syndrome) and bicuspid aortic valves. The underlying mechanisms remain uncertain. Even less is known regarding ascending aortic aneurysms in individuals with normal (i.e., tricuspid) aortic valves (TAV), and without known aneurysm-associated disorders. Regardless of etiology, the risk of aortic complications increases with biological age. Phenotypic modulation of smooth muscle cells (SMCs) is a feature of ascending aortic aneurysms, whereby contractile SMCs are replaced with synthetic SMCs that are capable of degrading the aortic wall. We asked whether age itself causes dysfunctional SMC phenotype modulation, independent of aortic dilatation or pre-existing aneurysm-associated diseases.MethodsNon-dilated ascending aortic samples were obtained intra-operatively from 40 patients undergoing aortic valve surgery (range: 20–82 years old, mean: 59.1 ± 15.2). Patients with known genetic diseases or aortic valve malformations were excluded. Tissue was divided, and a portion was formalin-fixed and immunolabeled for alpha-smooth muscle actin (ASMA), a contractile SMC protein, and markers of synthetic (vimentin) or senescent (p16/p21) SMCs. Another fragment was used for SMC isolation (n = 10). Cultured SMCs were fixed at cell passage 2 and stained for phenotype markers, or were cultured indefinitely to determine replicative capacity.ResultsIn whole tissue, ASMA decreased (R2 = 0.47, P < 0.0001), while vimentin increased (R2 = 0.33, P = 0.02) with age. In cultured SMCs, ASMA decreased (R2 = 0.35, P = 0.03) and vimentin increased (R2 = 0.25, P = 0.04) with age. p16 (R2 = 0.34, P = 0.02) and p21 (R2 = 0.29, P = 0.007) also increased with age in SMCs. Furthermore, the replicative capacity of SMCs from older patients was decreased compared to that of younger patients (P = 0.03).ConclusionBy investigating non-dilated aortic samples from individuals with normal TAVs, we found that age itself has a negative impact on SMCs in the ascending aortic wall, whereby SMCs switched from the contractile phenotype to maladaptive synthetic or senescent states with increased age. Therefore, based on our findings, modification of SMC phenotype should be studied as a therapeutic consideration against aneurysms in the future, regardless of etiology.

PurposeCurrent intervention guidelines for bicuspid aortic valve (BAV) associated ascending aorta (AAo) dilatation are suboptimal predictors of clinical outcome. There is growing interest in identifying better biomarkers such as wall shear stress (WSS) to help risk stratify BAV aortopathy. The aim of the systematic review is to synthesize existing evidence of the relationship between WSS and aortopathy in the BAV population.MethodsA comprehensive literature search of available major databases was performed in May 2022 to include studies that used four-dimensional flow cardiac magnetic resonance (4D-flow) MRI to quantify WSS in the AAo in adult BAV populations. Summary results and statistical analysis were provided for key numerical results. A narrative summary was provided to assess similarities between studies.ResultsA total of 26 studies that satisfied selection criteria and quality assessment were included in the review. The presence of BAV resulted in significantly elevated WSS magnitude and circumferential WSS, but not axial WSS. The presence of aortic stenosis had additional impact on WSS and flow alterations. BAV phenotypes were associated with different WSS distributions and flow profiles. Altered protein expression in the AAo wall associated with WSS supported the contribution of altered hemodynamics to aortopathy in addition to genetic factors.ConclusionWSS has the potential to be a valid biomarker for BAV aortopathy. Future work would benefit from larger study cohorts with longitudinal evaluations to further characterize WSS association with aortopathy, mortality, and morbidities.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337077, identifier CRD42022337077.

A patient with recurrent sepsis caused by an infected ascending aortic pseudoaneurysm was deemed unsuitable for surgery after the heart team evaluation. He successfully underwent percutaneous treatment with a combination of a septal occlusion device and coil embolization and remained free of sepsis 24 months after implantation.

Objectives: Certain aortic valve malformations predispose to ascending aortic aneurysm, although the mechanisms are incompletely understood. The aim of this study was to determine whether turbulence across the unicuspid aortic valve (UAV) contributes to regional differences in endothelial nitric oxide (eNOS) signaling in the ascending aortic wall. Methods: Samples were collected intraoperatively from the convex and concave ascending aortic wall from 64 patients with tricuspid aortic valves (TAVs; 25 nondilated, 17 dilated), or UAVs (9 nondilated, 13 dilated). Results: In normal-sized aortas, eNOS protein was decreased in UAV compared with TAV (P = .02) whereas mRNA was similar (P = .62). eNOS protein was increased in UAV-dilated aortas compared with UAV-nondilated aortas (P = .04), whereas dilatation had no impact on eNOS protein levels in TAV aortas (P = .73). Comparing only aneurysmal aortas, we found no difference in eNOS mRNA or protein between dilated TAV and UAV aortas (P = .26, P = .76). For eNOS mRNA and protein levels in normal and dilated UAV-associated aortas, no differences were found between concavity and convexity (all P > .05). This differed from dilated TAV aortas, which showed decreased eNOS mRNA in the convexity (P = .004) whereas eNOS protein levels were similar (P = .75). Conclusions: eNOS downregulation is observed in the UAV-associated ascending aorta and is apparently independent of dilatation. No regional differences were found, however, which would be expected if eNOS changes occur due to wall shear stress. This implies a congenital defect in eNOS signaling that may be stronger than turbulence-induced expression patterns. Further research should define the role of eNOS in aortopathy associated with aortic valve disease.

A 74-year-old man with a history of two thoracic aortic repairs, including a modified Bentall procedure using a mechanical valve and total arch replacement, was referred to our hospital with the development of hoarseness. Computed tomography revealed an anastomotic pseudoaneurysm between the prosthetic grafts in the ascending aorta. Two aortic cuffs for abdominal aorta were deployed through the left axillary artery using a transcatheter aortic valve replacement guidewire placed at the supra-aortic mechanical valve during ventricular rapid pacing and were successfully covered with an inlet to the pseudoaneurysm on postoperative computed tomography. The postoperative course was favorable. [ABSTRACT FROM AUTHOR]

Aim: The topography of vascular and valvular calcification could help accurately predict cardiovascular post-operative complications. The data on these calcifications remains scarce. Purpose: Identify the topographic distribution of the ascending aortic, left heart valves and coronary calcifications. Materials & methods: We extracted 26 variables from 557 patients, hospitalized between 2017 and 2020. The topography of calcification was evaluated by thoracic CT scans. Both multivariate logistic regression and classification and regression tree (CART) were used for statistical analysis. Results: Several comorbidities were associated with vascular or valvular calcification. This study proposes a CART tree for patients according to their age, sex, Euroscore and lipid profile. Conclusion: The proposed classification could represent an important clinical tool. More studies are warranted to better prune the current CART algorithm. [ABSTRACT FROM AUTHOR]

Medial degeneration is the most common histological finding in ascending aortic aneurysms with lesser but significant involvement by atherosclerosis. The overall extent and severity can be potentially underrated because of their uneven distribution and macroscopic inconspicuousness of medial degeneration. This study aims to compare the distribution of degenerative and atherosclerotic lesions around ascending aorta circumference, also considering aortic valve cuspidity. We evaluated 88 cases of resected ascending aortae, 25 with a tricuspid aortic valve and 63 with a malformed aortic valve, oriented by a cardiac surgeon and sent for pathological examination. We applied the consensus documents from 2015 and 2016 for microscopic evaluation of aortic specimens. The medial degeneration and atherosclerosis were graded semi-quantitatively for each aortic quadrant: convexity, anterior wall, concavity, and posterior wall. Nearly all quadrants showed at least mild medial degeneration; more severe findings of medial degeneration and atherosclerosis were in the aneurysms associated with the tricuspid valve. In the aneurysms with the tricuspid aortic valve, there was more frequent and more severe atherosclerosis at the concavity than at the anterior wall (p =.046); the frequency and severity of medial degeneration did not differ significantly. The aneurysms with a malformed aortic valve showed more severe medial degeneration at the concavity compared to the convexity (p =.011); atherosclerosis was less common and did not show any significant differences. More than half of the samples also revealed at least a one-grade (mostly one-grade) difference among the quadrants in individual cases for both atherosclerosis and medial degeneration. Extreme differences were rare except for atherosclerosis in the tricuspid group. The results revealed only slight overall differences around the aortic circumference, with concavity being the most susceptible. Still, thanks to occurring inter- and intraindividual variability, the examination of all quadrants seems meaningful not to miss the most severe changes and to underscore the findings. [ABSTRACT FROM AUTHOR]

We aimed to investigate the ability of the C-reactive protein-to-albumin ratio (CAR) to predict ascending aorta progression in patients with 40-50 mm diameter of ascending aortic dilatation. A total of 182 diagnosed patients with ascending aortic diameters of 40-50 mm were enrolled in this study. The study population was divided into tertiles based on yearly ascending aortic growth rate values. Group I (n = 137) was defined as a value in the lower 2 tertiles (ascending aorta growth ≤ 1.00 mm/year), and group II (n = 45) was defined as a value in the third tertile (ascending aorta growth > 1.00 mm/year). Hypertension, chronic obstructive pulmonary disease, positive family history, and CAR were found to be independent risk factors for ascending aorta growth > 1.00 mm/year. The area under the ROC curve (AUC) of CAR was 0.771(95% CI 0.689-0.854) for predicting ascending aorta growth > 1.00 mm/year. In patients with 40-50 mm ascending aneurysms, CAR may be useful to predict ascending aorta progression. [ABSTRACT FROM AUTHOR]

Background: Inflammatory aortic aneurysms represent less than 5% of ascending aortic aneurysms and are mostly diagnosed intraoperatively. Furthermore, to our knowledge, a case of an accompanying inflammatory LAD aneurysm has not been previously reported.Case Presentation: We report an unusual case of a 42-year-old female with a symptomatic inflammatory aneurysm of the ascending aorta and the LAD. The patient underwent successful resection and replacement of the aneurysm as well as bypass of the LAD.Conclusions: The underlying etiology of severe inflammatory ascending aortic aneurysms in a previously healthy individual remains unknown. The pre-operative diagnosis is difficult to obtain as it does not have a characteristic appearance on currently available imaging modalities. [ABSTRACT FROM AUTHOR]

Background: Ascending aorta and aortic arch diseases have an increasing interest among cardiovascular specialists regarding diagnosis and management. Innovations in endovascular surgery and evolution of open surgery have extended the indications for treatment in patients previously considered unfit for surgery. The aim of this systematic review of the literature was to present and analyze current cardiovascular guidelines for overlap and differences in their recommendations regarding ascending aorta and aortic arch diseases and the assessment of evidence. Methods: The English medical literature was searched using the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from January 2009 to December 2020. Recommendations on selected topics were analyzed, including issues from definitions and diagnosis (imaging and biomarkers) and indications for treatment to management, including surgical techniques, of the most important ascending aorta and aortic arch diseases. Results: The initial search identified 2414 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from multidisciplinary, cardiovascular societies published between 2010 and 2019. The definition of non-A-non-B aortic dissection is lacking from most of the guidelines. There is a disagreement regarding the class of recommendation and level of evidence for the diameter of ascending aorta as an indication. The indication for treatment of aortic disease may be individualized in specific cases while the growth rate may also affect the decision making. The role of endovascular techniques has not been established in current guidelines except by 1 society. Supportive evidence level in the management of aortic arch diseases remains limited. Conclusion: In current recommendations of cardiovascular societies, the ascending aorta and aortic arch remain a domain of open surgery despite the introduction of endovascular techniques. Recommendations of the included societies are mostly based on expert opinion, and the role of endovascular techniques has been highlighted only from 1 society. The chronological heterogeneity apparent among guidelines and the inconsistency in evidence level should be also acknowledged. More data are needed to develop more solid recommendations for the ascending aorta and aortic arch diseases. [ABSTRACT FROM AUTHOR]

Ascending aorta mycotic aneurysm is a rare entity. It is a life-threatening condition because of the possibility of aortic dissection, or rupture. Escherichia coli is recognised as an uncommon cause of aortic mycotic aneurysm. An 81-year-old woman with a history of Escherichia coli pyelonephritis 4 months previously, was admitted to our centre for a mycotic aneurysm of the ascending aorta caused by Escherichia coli. She was successfully treated by urgent in situ replacement of the ascending aorta with a cryopreserved homograft, combined with antibiotics. Although infrequent, Escherichia coli mycotic aneurysm should be suspected in older patients with atherosclerosis and who developed septicaemia. Prompt treatment with a combination of appropriate antibiotics and surgery is required. [ABSTRACT FROM AUTHOR]

Thoracic aorta pathologies, especially those of the ascending aorta and aortic arch, were traditionally approached via open surgical repair. This carries risk of ischemic end-organ damage and other complications. Endovascular repair of ascending aorta and aortic arch pathologies is becoming more successful and widespread, thereby posing numerous challenges to the anesthesiologist. This article reviews the anesthesia-pertinent pathophysiology, repair techniques, preoperative evaluation, intraoperative management, and postoperative care of patients presenting for endovascular repair of thoracic aorta pathologies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Valencia declares no conflicting interests. Dr Powell declares no conflicting interests. Dr Khalifa declares no conflicting interests. Dr Orozco-Sevilla consults and participates in clinical trials for Terumo Aortic, Cook Medical, and W.L. Gore & Associates. Dr Tolpin declares no conflicting interests.

The previous understanding has been that atherosclerosis tends to increase distally from the ascending aorta, but recent studies and practical experience have indicated that atherosclerosis occurs in the ascending aorta more than previously thought. Medial degeneration is linked to aortic aneurysms, dissection and dilatation and has been related to increased mortality. There is a lack of data on the coexistence of atherosclerosis and medial degeneration in the ascending aorta and its outcome to clinical morbidity and mortality. Earlier studies have shown coexisting atherosclerosis and medial degeneration as significant risk indicators for coronary and cerebrovascular events. We aimed to analyze aortic specimens classified according to the consensus documents of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology particularly the comparison of variable morphological features with the atherosclerotic grade to gain more data about the coexistence of atherosclerosis and medial degeneration. We evaluated 217 specimens of human ascending aorta resected at Tampere University Heart Hospital because of aortic aneurysm, dissection or dilatation. None of the samples contained normal aortic morphology; atherosclerosis was found in a total of 75.8 % of the samples and medial degeneration in all the samples. The present study is mostly in agreement with earlier research regarding the prevalence of different histological findings, even though a higher prevalence of atherosclerosis was found compared with most studies. There was no statistically significant association between atherosclerosis and medial degeneration, but a higher atherosclerotic grade was significantly associated with the presence of smooth muscle cell nuclei loss, smooth muscle cell disorganisation, elastic fibre thinning and medial fibrosis. Our study reinforces the perception that atherosclerotic lesions significantly occur in the ascending aorta and coexist with individual components of the medial degeneration., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Abstract Background Although aortic root and ascending aortic aneurysms are treated the same, they differ in embryological development and pathological processes. This study examines the microscopic structural differences between aortic root and ascending aortic aneurysms, correlating these features to the macroscopic pathophysiological processes. Methods We obtained surgical samples from ascending aortic aneurysms (n = 11), aortic root aneurysms (n = 3), and non-aneurysmal patients (n = 7), Aortic collagen and elastin content were examined via histological analysis, and immunohistochemistry techniques used to determine collagen I, III, and IV subtypes. Analysis was via observational features, and colour deconvolution quantification techniques. Results Elastin fiber disruption and fragmentation was the most extensive in the proximal aneurysmal regions. Medial fibrosis and collagen density increased in proximal aneurysmal regions and aortic root aneurysms (p

ObjectiveAdverse left ventricular remodeling due to a mismatch between stiffness of native aortic tissue and current polyester grafts may be under-recognized. This study was conducted to evaluate the impact of proximal aortic replacement on adverse remodeling of the left ventricle.Materials and methodsAll aortic root and ascending aortic aneurysm patients were identified (n = 2,001, 2006–2019). The study cohort consisted of a subset of patients (n = 98) with two or more electrocardiogram (ECG)-gated CT angiograms, but without concomitant aortic valve disease or bicuspid aortic valve, connective tissue disease, acute aortic syndrome or prior history of aortic repair or mitral valve surgery. LV myocardial mass was measured from CT data and indexed to body surface area (LVMI). The study cohort was divided into a surgery group (n = 47) and a control group; optimal medical therapy group (OMT, n = 51).ResultsThe mean age was 60 ± 11 years (80% male). Beta-blocker use was significantly more frequent in the surgery group (89 vs. 57%, p < 0.001), whereas, all other antihypertensive drugs were more frequent in the OMT group. The average follow-up was 9.1 ± 4.0 months for the surgery group and 13.7 ± 6.3 months for the OMT group. Average LVMI at baseline was similar in both groups (p = 0.934). LVMI increased significantly in the surgery group compared to the OMT group (3.7 ± 4.1 vs. 0.6 ± 4.4 g/m2, p = 0.001). Surgery, baseline LVMI, age, and sex were found to be independent predictors of LVMI increased on multivariable analysis.ConclusionProximal aortic repair with stiff polyester grafts was associated with increased LV mass in the first-year post-operative and may promote long-term adverse cardiac remodeling. Further studies should be considered to evaluate the competing effects of aortic aneurysm related mortality against risks of long-term graft induced aortic stiffening and the potential implications on current size thresholds for intervention.

Ascending aortic replacement is a challenging and complex surgery. The mortality, morbidity, and outcomes depend on the causes of the ascending aortic pathology and the type of operation. The research was conducted in a single-center, prospective, observational cohort study of patients undergoing ascending aortic replacement due to dissection or aneurysm. In the hospital, mortality, morbidity, and short-term outcomes were measured. A total of 85 patients were included in this study. Of them, 65.9% were male, and 34.1% were female. Thirty-three patients had Stanford type A aortic dissection (STAAD), whereas 52 had ascending aortic aneurysm (ASAA). Early mortality was (21.21% and 1.9%) for STAAD and ASAA, respectively, while the survival rate after one year was (75.8% and 96.15 %) for ascending dissection and aneurysm, respectively. The results of our study show higher early surgical mortality and morbidity and a lower short-term survival rate for STAAD surgery compared with ASAA surgery.

ObjectiveWhile aneurysm of the aortic root, interrupted aortic arch, and aortic coarctation are the most frequent aortic diseases in adolescents and younger adults, there are a number of rare pathologies of the thoracic aorta that need individualized treatment.PatientsWe present a small case series of unusual aortic pathologies in patients presenting with a broad spectrum of symptoms: tiredness, dysphagia, dyspnea, arterial hypertension, renal failure, and claudication. (1). Segmental agenesia of the descending aorta. (2). Balanced double aortic arch with complete vascular ring. (3). Right descending aortic arch, left lusorian artery with Kommerell diverticulum. (4). Large patent ductus (2.5 cm) and ventricular septal defect. (5). Aneurysm of the aortic arch in the presence of tuberous sclerosis. (6). Pseudo-aneurysm of the proximal descending aorta following coarctation patch plasty. (7). Supravalvular aortic stenosis combined with severe aortic valve stenosis. (8). Pseudo-aneurysm following ascendens-to-descendens bypass because of recurrent coarctation. (9). Takayasu arteriitis with severe stenosis in the thoraco-abdominal aorta.ResultsThe following procedures were performed, using individualized cardiopulmonary bypass, canulation and cerebral protection strategies. (1). Ascending to supraceliac extra-anatomic bypass. (2). Division of the ductus ligament and of the anterior aortic arch distally to the left subclavian artery. (3). Excision of the Kommerell diverticulum and translocation of the left subclavian artery. (4). Patch closure of the aorto-pulmonary window (patent ductus) and closure of the ventricular septal defect. (5). Complete aortic arch replacement combined with debranching of the supra-aortic vessels. (6). Graft interposition of the proximal descending aorta. (7). Enlargement of the ascending aorta and aortic valve replacement. (8). Exclusion of the pseudo-aneurysm, end-to-side graft interposition. (9). Ascending aorta to infrarenal aorta or ascending to bi-iliac artery bypass (planned). All patients were operated on without operative mortality. One patient died in-hospital from pulmonary complications one week after surgery. One patient is still awaiting surgery. All other patients recovered very well from the operation and did not show any residual symptoms.ConclusionRare pathologies of the thoracic aorta in younger patients may cause a broad spectrum of unusual symptoms; in some of them, diagnosis is delayed. Cross-sectional imaging is mandatory for optimal operative planning Surgical treatment can be performed with very satisfying results. The prognosis of these patients is usually favorable following surgery.