Document Detail


Ascending aortic curvature as an independent risk factor for type A dissection, and ascending aortic aneurysm formation: a mathematical model.
MedLine Citation:
PMID:  18434179     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To develop a mathematical model to demonstrate that ascending aortic curvature is an independent risk factor for type A dissections, in addition to hypertension, bicuspid aortic valve, aneurysm of ascending aorta, and intrinsic aortic tissue abnormalities, like Marfan's syndrome.
METHODS: A steady state one-dimensional flow analysis was performed, utilising Newton's third law of motion. Five different clinical scenarios were evaluated: (1) effect of aortic curvature; (2) effect of beta-blockers, (3) effect of patient size, (4) forces on a Marfan's aorta, and (5) site of entry flap in aortic dissection.
RESULTS: Aortic curvature increases the forces exerted on the ascending aorta by a factor of over 10-fold. Aortic curvature can cause patients with a systolic blood pressure of 8 0mmHg to have greater forces exerted on their aorta despite smaller diameters and lower cardiac outputs, than patients with systolic blood pressures of 120 mmHg. In normal diameter aortas, beta-blockers have minimal effect compared with aortic curvature. Aortic curvature may help to explain why normal diameter aortas can dissect, and also that the point of the entry tear may be potentially predictable. Aortic curvature has major effects on the forces exerted on the aorta in patients with Marfan's syndrome.
CONCLUSIONS: Aortic curvature is relatively more important that aortic diameter, blood pressure, cardiac output, beta-blocker use, and patient size with regard to the force acting on the aortic wall. This may explain why some patients with normal diameter ascending aortas with or without Marfan's syndrome develop type A dissections and aneurysms. Aortic curvature may also help to explain the site of entry tear in acute type A dissection. Further clinical study is needed to validate this study's finding.
Authors:
Michael P Poullis; Richard Warwick; Aung Oo; Robert J Poole
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Publication Detail:
Type:  Journal Article     Date:  2008-04-22
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  33     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-16     Completed Date:  2008-08-21     Revised Date:  2012-11-29    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  995-1001     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Thomas Drive, Liverpool L14 3PE, United Kingdom. mike.poullis@ctc.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology
Aneurysm, Dissecting / etiology*,  pathology*,  physiopathology,  radiography
Aorta / drug effects,  physiopathology
Aortic Aneurysm / etiology*,  pathology*,  physiopathology,  radiography
Aortography
Blood Pressure
Body Weight
Cardiac Output
Hemorheology
Humans
Marfan Syndrome / physiopathology
Models, Cardiovascular*
Risk Factors
Tomography, X-Ray Computed
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2012 Oct;42(4):755; author reply 756   [PMID:  22564807 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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