The Karl VanDevender Lectureship in Clinical Pearls … Karl VanDevender Lectureship in Clinical Pearls – The Aorta •Aortic Anatomy •How to measure the Aorta •Guilt by Association
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The Karl VanDevender Lectureship in Clinical Pearls – The Aorta
• Aortic Anatomy
• How to measure the Aorta
• Guilt by Association – Physical Findings and Diseases linked to Aortopathy
• Genetics
• Aortic Dissection usually has a Proximate cause
• Personalized External Aortic Root Support (PEARS)
Authors/Task Force members et al. Eur Heart J 2014;35:2873-2926
Was the Aorta Measured Correctly? Measure the Aorta perpendicular to the direction of blood flow
Copyright © 2008 by the American Roentgen Ray Society
Ko, S.-F. et al. Am. J. Roentgenol. 2005;184:1225-1230
Was the Aorta Measured Correctly? Gated CTA is essential to eliminate motion artifact involving the Ascending Aorta
Copyright ©2010 American College of Cardiology Foundation. Restrictions may apply.
Elefteriades, J. A. et al. J Am Coll Cardiol 2010;55:841-857
Was the Aorta Measured Correctly? Which Is the True "Diameter?"
“Guilt by Association” for detection of silent Thoracic Aortic Aneurysms
John A Elefteriades et al. Open Heart 2015;2:e000169
©2015 by British Cardiovascular Society
Precipitating Events for Aortic Dissection
• The date and time that Acute Aortic Dissection occurs is not random
• Circadian and diurnal patterns
• Emotional or Exertional Events
• Risks of weight lifting
Copyright ©2010 American College of Cardiology Foundation. Restrictions may apply.
Elefteriades, J. A. et al. J Am Coll Cardiol 2010;55:841-857
Conceptual Pathway Leading to Acute Aortic Dissection
Genetics
• Abdominal Aortic Aneurysm is a disease driven primarily by atherosclerosis
Smoking, HTN, Diabetes Mellitus, Male gender
• Genetics are more prominent in Thoracic Aortic Aneurysms
20% of Probands have a first-degree relative with a dilated thoracic aorta
• Genetically triggered Thoracic Aortic Disease invariably involves the Ascending Aorta
Phenotypes of age-matched patients with transforming growth factor-β vasculopathy and
smooth muscle contraction vasculopathy.
Eric M. Isselbacher et al. Circulation. 2016;133:2516-2528
Copyright © American Heart Association, Inc. All rights reserved.
ExoVasc Personalized External Aortic Root Support
• Tal Golesworthy – Engineer and Marfan patient with enlarging Aortic Root
• Options of a Bentall Procedure or Valve Sparing Aortic Root Replacement
• 2000 met with Cardiac Surgeon Tom Treasure after a Marfan Association meeting in the UK
• 2004 First implant of the ExoVasc in Tal Golesworthy
• 2011 National Institute for Clinical Excellence (NICE) issued a full guidance in the UK on External Aortic Root Support in MFS
Personalized External Aortic Root Support
Nashville and London
• Approved in the United Kingdom
• Over 60 patients have been implanted
• Medical Tourism for Marfan Patients
• HCA Hospitals in London partnering with TriStar Centennial to perform preoperative imaging in Nashville
• Trans Atlantic Aortic Conference
Schematic representation of the four ways in which acute aortic dissection can take a patient's life: (1) intrapericardial rupture, leading to cardiac tamponade; (2) free rupture, usually into the
left pleural space; (3) acute aortic insufficiency, which is...
John A Elefteriades et al. Open Heart 2015;2:e000169
©2015 by British Cardiovascular Society
Figure 4
The Lancet 2015 385, 800-811DOI: (10.1016/S0140-6736(14)61005-9)
Copyright © 2015 Elsevier Ltd Terms and Conditions
An ascending aorta so thin that the writing on a ruler can be read directly through the wall.
John A Elefteriades et al. Open Heart 2015;2:e000169
©2015 by British Cardiovascular Society
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