OBJECTIVES: Evidence regarding the behaviour of sporadic aortic aneurysm (TAA) is limited. We reviwed factors influencing the complications of rupture and dissection in order to give some suggestions which might be used as possible criteria to surgical intervention. METHODS: Aortic specimens were obtained from 161 patients (127 men and 34 women, age 63 ± 10.7 years) undergoing surgical repair of TAA and 18 patients (13 men and 5 women; age: 66.16 ± 9.87 years) undergoing surgical repair for Stanford type A aortic dissection (TAD). A control group of 128 subjects (61 men and 67 woman, age 61.1 ± 5.8 years) was also enrolled. Histopathological and immunohis- tochemical analyses were performed using adequate tissue specimens, appropriatetechniques and criteria. Genetic risk factors were also investigated. We analysed the potential role of ten common single nucleotide polymorphisms (SNP)s of the fol- lowing genes: CCR5 (Chemokine C Receptor-5), TLR4 (Toll like Receptor-4), MMP-9 (Metalloproteinases-9), MMP-2 (Metalloproteinases-2), ACE (Angiotensin Converting Enzyme), eNOs (endothelial Nitric Oxide synthase). RESULTS: In the most cases of TAD, ascending aorta is not dilated. TAD is associ- ated with elevated cystic medial degeneration, without substitutive fibrosis, plurifocal medial apoptosis and severe collagenases concentration. Very significant associations were observed between –786T/C eNOs, D/I ACE, –735C/T MMP-2 SNPs and TAD risk. In the case of TAA, we identify three phenotypes in case aorta samples: pheno- type I (normal wall); phenotype II (moderate wall thickness); phenotype III (thin and weak wall). No significant differences were detected in term of aortic diameter at the time of operation. Significant statistical differences were observed by comparing abnormalities of extracellular matrix components among three phenotypes (fibrosis p < 0.005; elastic fragmentation p = 0.002; medionecrosis p = 0.004; cystic necrosis p = 0.07; apoptosis p < 0.0001; MMP-9 amount p = 0.004). Significant differences both in genotype distributions and allele frequencies were observed for following SNPs: –1562C/T MMP-9, –786T/C eNOs, +896A/G TLR4, and D/I ACE. In particular patients with TAA phenotype III showed the same histological and genetic features of TAD despite the mean diameter of ascending aorta was smaller than TAA pheno- type I and II. CONCLUSIONS: Our suggestion is that the median diameter of ascending aorta is not a sure criteria for surgical indication in patient with TAA, other biomarkers (i.e. histopathological phenotypes and genetic factors) need to be used for an appropriate surgical indication to prevent catastrophic complications of rupture and dissection, Thus, we emphasize this strong aspect to arouse particular interest in the scientific cardio-surgery committee to suggest more appropriate guidelines for a disease with a very increasing incidence in Western populations.
Pisano, C., Balistreri, C., Triolo, O., Merlo, D., Argano, V., Palmeri, C., et al. (2014). Sporadic Ascending Aortic Aneurysm: Is it the Diameter of Ascending Aorta a Good Criterion for Surgical Indication?. In Western Thoracic Surgical Association , 40th Annual Meeting,The ST. Regis Monarch Beach Dana Point (California), California.
|Autori:||Pisano, C; Balistreri, C; Triolo, O; Merlo, D; Argano, V; Palmeri, C; Ruvolo, G|
|Titolo:||Sporadic Ascending Aortic Aneurysm: Is it the Diameter of Ascending Aorta a Good Criterion for Surgical Indication?|
|Nome del convegno:||Western Thoracic Surgical Association , 40th Annual Meeting|
|Luogo del convegno:||The ST. Regis Monarch Beach, Dana Point, California|
|Anno del convegno:||2014|
|Data di pubblicazione:||giu-2014|
|Settore Scientifico Disciplinare:||Settore MED/23 - Chirurgia Cardiaca|
|Tipologia:||Intervento a convegno|
|Citazione:||Pisano, C., Balistreri, C., Triolo, O., Merlo, D., Argano, V., Palmeri, C., et al. (2014). Sporadic Ascending Aortic Aneurysm: Is it the Diameter of Ascending Aorta a Good Criterion for Surgical Indication?. In Western Thoracic Surgical Association , 40th Annual Meeting,The ST. Regis Monarch Beach Dana Point (California), California.|
|Appare nelle tipologie:||02 - Intervento a convegno|