Changes in aortic root dimensions after ascending aortic repair with concomitant aortic valve replacement

The issue of ascending aortic repair with concomitant aortic valve replacement in pa-tients with ascending aortic aneurysm (AscAA) and aortic valve stenosis is still debatable.Aim. To analyze the dimension changes of the preserved aortic root after simultaneous ascending aorta repair and aortic valve replacement.Material and methods. This retrospective study included 102 patients who, from December 2012 to May 2022, underwent simultaneous aortic valve replacement and ascending aorta repair with hemiarch replacement. Patients were divided into 2 following groups based on the aortic valve morphology: group 1 — patients with bicuspid aortic valve (BAV) and AscAA (n=75), group 2 — patients with tricuspid aortic valve (TAV) and AscAA (n=27). Depending on the presence of aortic root dilatation (maximum diameter (d) >40 mm), each of the groups was additionally stratified into 2 more subgroups as follows: patients without aortic root dilatation (d≤40 mm) and patients with its dilatation (d>40 mm). The dynamics of the aortic root diameter was assessed by computed tomography angiography.Results. The mean follow-up period for patients was 36,2±14,6 months. Survival rate in the BAV+AscAA and TAV+AscAA groups was 96% and 100%, respectively (p=0,380). Freedom from aortic root resurgery was 100% in both study groups. In patients with dilated and non-dilated aortic root of the BAV+AscAA group, an increase in aortic root dimension was noted at a rate of 0,65±0,51 mm/year and 0,32±0,27 mm/year, respectively. In patients of the TAV+AscAA group, a regression in dilated and non-dilated aortic root diameter was observed as follows: 0,93±0,48 mm/year and 0,56±0,43 mm/year, respectively.Conclusion. In patients with AscAA in combination with BAV stenosis after a singlestep surgical intervention, a weak negative dynamics of non-dilated and dilated aortic root is observed in the mid-term follow-up period. In patients with AscAA and TAV, there is involutive alterations of the aortic root dimension during 3-year follow-up

Особенности эластических свойств дилатированной и аневризматически расширенной грудной аорты по данным ЭКГ-синхронизированной КТ-ангиографии

Purpose: to compare the indicators of elasticity of the thoracic aorta, determined by ECG-Gated-CT angiography, in patients with ascending aortic aneurysm and dilatation.Materials and methods. The study included 20 patients with dilatation of the ascending aorta (40 mm ≤ maximum aortic diameter (Dmax) < 50 mm) (group 1a), 30 patients with non-syndromic aneurysms of the ascending aorta (n = 30, Dmax ≥ 50 mm) (group 1b), as well as 19 patients with normal aortic sizes (Dmax < 40 mm) as controls (group 2). All patients underwent multispiral computed tomography angiography of the aorta in ECG-Gated mode (ECG-Gated -CT). Maximum systolic and diastolic aortic diameters (Dmax) were measured at different levels of the thoracic aorta, followed by calculation of the difference between them and calculation of the circular deformation (CS), compliance, stiffness (Stiff), wall distensibility, longitudinal deformation (LS).Results. Moderate negative correlation between the age of the patients and CS at all levels of the thoracic aorta (rmaximum = –0.33, rminimum = –0.41) was revealed. Groups 1a and 1b did not differ significantly in all parameters. Group 1a differed from the control group (p < 0.05) in Stiff at the level of the aortic annulus (AA) (0.07 [–0.14; 0.15] vs –0.04 [–0.1; 0.06]), as well as CS at the level of AA and sinuses of Valsalva (SV ) (0.49 [–2.94; 3.36] vs –1.18 [–4.51; 3.87]), and group 1b – in CS at the level of SV (3.73 [0.24; 6.56] vs 0.13 [–1.42; 3.04]) and proximal part of the descending aorta (distal to the left subclavian artery) (5.48 [1.27; 8.40] vs 1.97 [–0.32; 6.08]), also in LS (5.96 [–8.98; 9.25] vs –2.58 [–7.75; 1.89]) at the level of the aortic arch.Conclusion. According to ECG-Gated-CT angiography, the indicators of elasticity of the thoracic aorta in patients with ascending aortic aneurysm and dilatation did not differ. Compared with the control group, patients with aneurysm of the ascending aorta showed an increased pulse deformity of the non-dilated aortic arch.Цель исследования: сопоставить показатели эластичности грудной аорты, определенные по данным ЭКГ-синхронизированной КТ-ангиографии, у пациентов с аневризмой и дилатацией восходящего отдела.Материал и методы. В исследование было включено 20 пациентов c дилатацией восходящей аорты (40 мм ≤ максимальный диаметр аорты (Dmax) < 50 мм) (подгруппа 1а), 30 больных с несиндромными аневризмами восходящей аорты (n = 30, Dmax ≥ 50 мм) (подгруппа 1б), а также 19 больных с нормальными размерами сосуда (Dmax < 40 мм) в качестве контроля (группа 2). Всем пациентам была выполнена мультиспиральная компьютерно-томографическая ангиография аорты в ЭКГ-синхронизированном режиме (ЭКГсинхр.-КТ). На различных уровнях грудной аорты измеряли максимальный систолический и диастолический диаметр сосуда (Dmax) с последующим расчетом разницы между ними и индексов циркулярной деформации (CS), комплаенса, жесткости (Stiff), растяжимости стенки (для всех уровней), продольной деформации (LS).Результаты. По результатам анализа была выявлена умеренная отрицательная корреляционная взаимосвязь между возрастом пациентов и CS на всех уровнях грудной аорты (rmax = –0,33, rmin = –0,41). Подгруппы 1а и 1б по всем показателям значимо не различались. От группы контроля подгруппа 1а отличалась (p < 0,05) по Stiff на уровне фиброзного кольца (ФК) аортального клапана (0,07 [–0,14; 0,15] vs –0,04 [–0,1; 0,06]), а также CS на уровне ФК и синусов Вальсальвы (СВ) (0,49 [–2,94; 3,36] vs –1,18 [–4,51; 3,87]), а подгруппа 1б – по CS на уровне СВ (3,73 [0,24; 6,56] vs 0,13 [–1,42; 3,04]) и проксималного отдела нисходящей аорты (дистальнее устья левой подключичной артерии) (5,48 [1,27; 8,40] vs 1,97 [–0,32; 6,08]), также по LS (5,96 [–8,98; 9,25] vs –2,58 [–7,75; 1,89]) на уровне дуги аорты.Заключение. По данным ЭКГсинхр. КТ-ангиографии показатели эластичности грудной аорты у пациентов с аневризмой и дилатацией восходящего отдела не различаются. По сравнению с группой контроля у больных с аневризмой восходящего отдела аорты отмечается увеличение пульсовой деформации в недилатированной зоне (дуге аорты)