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

The Karl VanDevender Lectureship in Clinical Pearls

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

Classification of Aortic Dissection

Authors/Task Force members et al. Eur Heart J 2014;35:2873-2926

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

Hatzaras, et al. Am J Cardio.2007;100:1470-2

Precipitating Events for Acute Aortic Dissection

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

Elefteriades, J. A. et al Sci AM 2005;293:2803

BP Response to Weight Lifting: Extreme Hypertension

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.

GeneDx Genetic Testing

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

Computer-Aided Design and Rapid Prototyping also known as 3D Printing

The Lancet Volume 365, Issue 9459, (February 2005)

DOI: 10.1016/S0140-6736(05)17894-5

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

The Karl VanDevender Lecture Series in Clinical Pearls

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

Is This a Genetic Condition?