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Thoracic Aortic Aneurysm: Reading ttable he Enemy’s Playbook

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Abstract

Background

The purpose of the present study was to use the clinical database at the Yale University Center for Thoracic Aortic Disease to shed light on the pathophysiology of thoracic aortic aneurysm (TAA), the clinical behavior of thoracic aortic aneurysm, and the optimal clinical management.

Materials and Methods

The Yale database contains information on 3,000 patients with thoracic aortic aneurysm, with 9,000 patient-years of follow-up and 9,000 imaging studies. Advanced statistical techniques were applied to this information.

Results

Analysis provided the following observations: (1) TAA is a genetic disease with a predominantly autosomal dominant mode of inheritance, (2) matrix metalloproteinase (MMP) enzymes are activated in the pathogenesis of TAA, (3) wall tension in TAA approaches the tensile limits of aortic tissue at a diameter of 6 cm, (4) by the time a TAA reaches a clinical diameter of 6 cm, 34% of affected patients have suffered dissection or rupture, (5) extreme physical exertion or severe emotion often precipitate acute dissection, and (6) single nucleotide polymorphisms (SNPs) are being identified which predispose a patient to TAA.

Conclusions

The “playbook” of TAA is gradually being read, with the help of scientific investigations, positioning practitioners to combat this lethal disease more effectively than ever before.

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References

  1. Anagnostopoulos CE (1975) Acute Aortic Dissection, University Park Press

  2. Morales DLS, Quin JA, Braxton JH, et al. (1998) Experimental confirmation of effectiveness of fenestration in acute aortic dissection. Ann Thorac Surg 66:1679–1683

    Article  PubMed  CAS  Google Scholar 

  3. Coady MA, Davies RB, Roberts M, et al. (1999) Familial patterns of thoracic aortic aneurysm. Arch Surg 134:361–367

    Article  PubMed  CAS  Google Scholar 

  4. Hatzaras IS, Bible JE, Kallias GJ, et al. (2007) Role of exertion or emotion as inciting events for acute aortic dissection. Am J Cardiol 100:1470–1472

    Article  PubMed  Google Scholar 

  5. Coady MA, Rizzo JA, Hammond GL, et al. (1997) What is the appropriate size criterion for resection of thoracic aortic aneurysm? J Thorac Cardiovasc Surg 113:476–491

    Article  PubMed  CAS  Google Scholar 

  6. Davies RR, Goldstein LJ, Coady MA, et al. (2001) Yearly rupture rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 73:17–27

    Article  Google Scholar 

  7. Cohen LS (1996) Diseases of the aorta. In Bennet JC, Plum F, (editors), Cecil Textbook of Medicine, 20th Edition, W.B. Saunders Company, Philadelphia

    Google Scholar 

  8. Scholl FG, Coady MA, Davies R, et al. (1999) Interval or permanent nonoperative management of acute type A aortic dissection. Arch Surg 134:402–5

    Article  PubMed  CAS  Google Scholar 

  9. Elefteriades JA, Hartleroad J, Gusberg RJ, et al. (1992) Long-term experience with descending aortic dissection: the complication-specific approach. Ann Thorac Surg 53:11–21

    Article  PubMed  CAS  Google Scholar 

  10. Svensson LG, Crawford ES, Hess KR, et al. (1990) Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. Circulation 82(5 Suppl): IV24–38

    PubMed  CAS  Google Scholar 

  11. Coady MA, Rizzo JA, Elefteriades JA (1999) Pathologic variants of thoracic aortic dissections: penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin North Am 17:637–657

    Article  CAS  Google Scholar 

  12. Juvonen T, Ergin MA, Galla JD, et al. (1999) Risk factors for rupture of chronic type B dissections. J Thorac Cardiovasc Surg 117:776–786

    Article  PubMed  CAS  Google Scholar 

  13. Wagner FA, Cosman DV, Cohen JL, et al. (2002) Isolated dissection of the abdominal aorta: clinical presentation and therapeutic options. J Vasc Surg 36:205–210

    Article  PubMed  Google Scholar 

  14. Wong Y, Barbacioru CC, Shiffman D, et al. (2007) Gene expression signature in peripheral blood detects thoracic aortic aneurysm. PLoS ONE 2:e1050

    Article  CAS  Google Scholar 

  15. Davies RR, Gallo A, Coady MA, et al. (2006) Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg 81:169–177

    Article  PubMed  Google Scholar 

  16. Elefteriades J, Lovoulos CJ, Coady MA, et al. (1999) Management of descending aortic dissection. Ann Thorac Surg 67:2002–2005

    Article  PubMed  CAS  Google Scholar 

  17. Coady MA, Rizzo JA, Hammond GL, et al. (1999) Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications. Ann Thorac Surg 67:1922–1926

    Article  PubMed  CAS  Google Scholar 

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Correspondence to John A. Elefteriades.

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Elefteriades, J.A. Thoracic Aortic Aneurysm: Reading ttable he Enemy’s Playbook. World J Surg 32, 366–374 (2008). https://doi.org/10.1007/s00268-007-9398-3

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