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Eur J Cardiothorac Surg 2005;28:857-863
© 2005 Elsevier Science NL
a Department of Surgery, Unita’ Operativa di Chirurgia dell’ Aorta Toracica, Universita’ agli Studi di Siena, Policlinico le Scotte, Viale M. Bracci, 53100 Siena, Italy
b Department of Quantitative Methodology, Universita’ agli Studi di Siena, Italy
c Service de Chirurgie Thoracique et Cardiovasculaire, CHU de Caen, France
d Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
Received 10 May 2005; received in revised form 26 September 2005; accepted 3 October 2005.
* Corresponding author. Tel.: +39 0577 585733; fax: +39 0577 281937. (Email: euxneri{at}tin.it; nerie{at}unisi.it).
Objective: Increased dimension of the aortic root and proximal aorta is considered a significant risk factor for catastrophic events that involve the ascending aorta. The objective of this study was to determine the possible correlation between pre-dissection aortic diameter and the occurrence of Stanford type A aortic dissection. Methods: Samples of dissected ascending aortas were obtained from 220 patients at the time of their operation. Two groups were identified: patients with connective tissue disorders (Group 1, n = 94) and those without (Group 2, n = 126). Measurements of the true (intimal) lumen were conducted and extrapolated as reliable approximation of pre-dissection aortic diameter. The possible association of intimal diameter with anthropometric and demographic data was analyzed. Results: Median aortic diameter was, respectively, 41.8 and 41.3 mm for patients with and without connective tissue disorders (41.4 mm for the entire cohort). Data analysis indicated that 57% of patients had aortic diameter above 40 mm, while patients with frank aneurysm accounted only for 10%; this proportion was higher in Group 1 compared to Group 2 (17.2% vs 4.7%). Poor or no correlation was demonstrated between aortic size and any of the anthropometric or demographic variables essayed. Significant subgroup differences were found among patients with a history of cigarette smoking, hypertension, diabetes, chronic renal insufficiency, and bicuspid aortic valve. Conclusion: Although aortic diameter remains a strong indication for preventive surgery in patients with inherited connective tissue disorders, acute aortic dissection occurs rarely in the setting of true ascending aortic aneurysms, and despite normal or near-normal aortic size in more than one-third of subjects. Dissection superimposing on small aortic diameters can be regarded as an expression of substantial functional tissue susceptibility to aortic catastrophic events.
Key Words: Aorta • Dissection • Marfan syndrome
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