Predissection-derived geometric and distensibility indices reveal increased peak longitudinal stress and stiffness in patients sustaining acute type A aortic dissection: Implications for predicting dissection

The Journal of Thoracic and Cardiovascular Surgery

James Thunes¹  Leonid Emerel²  Trevor Kickliter³ 

[1] Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pa;Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa;McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pa

关键词: aortic aneurysm;    aortic dissection;    aortic wall stress;    aortic biomechanical properties;   

DOI  :  10.1016/j.jtcvs.2018.10.116

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo assess ascending aortic distensibility and build geometry and distensibility-based patient-specific stress distribution maps in patients sustaining type A aortic dissection (TAAD) using predissection noninvasive imaging.MethodsReview of charts from patients undergoing surgical repair of TAAD (n = 351) led to the selection of a subset population (n = 7) with 2 or more predissection computed tomography angiography scans and echocardiograms at least 1 year before dissection. Ascending aortic wall biomechanical properties (aortic strain, distensibility, and stiffness) were compared with age- and size-matched nondissected nonaneurysmal controls. Patient-specific aortic strain served as an input in aortic geometry-based simulated 3-dimensional reconstructions to generate longitudinal and circumferential wall stress maps. Inspection of perioperative dissection scans and intraoperative visual examination confirmed primary tear locations.ResultsPredissection echocardiography revealed ascending aortas of patients sustaining TAAD to exhibit decreased aortic wall strain (14.50 ± 1.13% vs 8.49 ± 1.08%; P −6 cm2·dyne−1; P P P ConclusionsUsing predissection imaging, we identified increased stiffness and longitudinal wall stress in ascending aortas of patients with dissection. Patient-specific imaging-derived biomechanical property maps like these may be instrumental toward designing better prediction models of aortic dissection potential.

【 授权许可】

Unknown