Aorta

RAMA

Aorta
Anatomie Aorta afmetingen Aneurysma Dissectie Behandeling Atheroma SEC Echo beeld in AI Congenitale afwijkingen

Aorta afmeting-waarom???

Anatomie

Anatomie aorta ascendens

echocardiography. The aortic diameter measured at the aortic annulus (1), the sinuses of Valsalva (2), the supra-aortic ridge (3), and the proximal ascending aorta (4). In Marfan syndrome, dilatation usually starts at the sinuses of Valsalva, so this measurement is critical in monitoring the early evolution of the condition. Diameters must be related to normal values for age and body surface area.

Aorta dimensies-TEE

Cohen et al made various cardiac measurements using transoesophageal echocardiography in a group of 60 normal adults. These authors found the following aortic dimensions:

Aortic Annulus Tran-sinus Sino-tubular junction Ascending aorta

1.4 - 2.6 cms 2.1 - 3.5 cms 1.7 - 3.4 cms 2.1 - 3.4 cms

Aortic arch
Area

2.0 - 3.6 cms

2.4 - 3.5 cms^2

Aorta dimensies-Ctscan
Hager et al who have reported the diameter of the thoracic

aorta at various sites as measured by helical computed tomography. In a group of 70 normal adults, these authors reported the following aortic dimensions:

Tran-sinus Ascending aorta Distal Aortic arch Diaphragm

2.98 +/- 0.46 cms 3.09 +/- 0.41 cms 2.47 +/- 0.40 cms 2.43 +/- 0.35 cms

 Beperking van echo cor: Beperkte zicht op prox aorta

 C shape van aorta Metingen van diameter CT

scan niet altijd accuraat

 Axiale beelden van ctscan Diameter van proximale aorta moeilijk te meten door bochtige/ geelongeerde aorta

 Loss of Normal "Waist" at

Sinotubular Junction: A Sign of Intrinsic Aortic Disease A-normaal B-abnormal aortic contour (with no "waist") of Marfan-like annuloaortic ectasia

Diameter sinus van valsalva

Which Is the True "Diameter? Geometric complexity of measuring aortic diameter

Toename incidentie van Aneurysma

increased incidence of

ruptured abdominal aortic aneurysm in the total population of Malm, Sweden, between 1971 and 2004.

Aortic Size Index Nomogram

Depiction of "Hinge Points" for Lifetime Natural History Complications at Various Sizes of the Aorta The y-axis lists the probability of complication; complication refers to rupture or dissection

Dissections Do Occur at Small Sizes

Distribution of aortic size at the time of presentation with acute type A aortic dissection

 Aortic Aneurysm Is Really 2

Diseases: Ascending Disease Differs Markedly From Descending/Abdominal Disease thoracic aneurysm disease divides naturally into 2 patterns, separated at the ligamentum. Above the ligamentum, the aorta is thin, but not atherosclerotic; below the ligamentum, as with abdominal aortic aneurysms, heavy arteriosclerosis and calcification predominate

Survival With Thoracic Aneurysms of Various Sizes

Five-year hazard estimates are illustrated for patients as a function of initial aneurysm size

That Acute Aortic Dissection Occurs Is Not Random"

Pt:Ascending Aortic Aneurysm

ascending aortic aneurysm

aneurysm was associated with marked dilatation of the

aortic annulus such that the annular diameter was 3.8 cms (normal range:1.4 - 2.6 cms).
This dilatation was associated with severe aortic

incompetence.
Further 2D examination of the valve demonstrated

completely normal leaflet morphology.

Note also, the complete effacement of the sino-tubular

junction.

ascending aortic aneurysm

This patient was a young man. In such cases,

Marfan's and Ehlers-Danlos' syndrome and the presence of a Bicuspid Aortic Valve (BAV) are recognised as specific risk factors for aneurysm formation.

The genetic basis for

Marfan syndrome is now well-accepted as being a mutation in the gene for fibrillin-1 and the Ehlers-Danlos syndrome is believed to result from mutations in the gene for type III procollagen (COL3A1).

There is a strong relationship between the presence of a BAV and the development of ascending aortic aneurysm - even in the absence of aortic stenosis. This has been attributed to the presence of significant histological abnormalities in the aortic wall of patients with BAV (Matthias Bechtel et al).

Ziekte van marfan

autosomal dominant disorder, characteristically with cardiovascular, eye and skeletal, features. The minimal birth incidence is 1 in 9800 27% of cases arise from new mutation Mutation in fibrillin-1 on chromosome 15 is detected in 6691% of cases Some cases may be due to mutation in TGFbetaRl or TGFbetaR2 TGFbetaR1 or TGFbetaR2 are also associated with Loeys-Dietz syndrome, and TGFbetaR2 with familial thoracic aortic aneurysm The clinical diagnosis in adults should be made using the Ghent criteria Prophylactic medical treatment to protect the aorta with regular follow-up helps prevent or delay serious complications

Prophylactic aortic surgery when the aortic root at the Sinus of Valsalva exceeds 5 cm

Aorta dissectie

Aortic Dissection (Ascending)

Type B dissectie

classification

DEBAKEY: 1. Dissection involving the ascending and descending aorta and aortic arch (10 %). 2. Dissection involving only the ascending aorta and aortic arch (60%). 3. Dissection involving only the descending aorta only (30 % ).

STANFORD: 'A'. Debakey types 1 and 2: i.e. involves the ascending aorta. 'B'. Debakey type 3: i.e. involves only the descending aorta.

Although anatomically more specific than the Stanford classification, the Debakey system seems to be less-widely used and less clinically useful than the Stanford classification.

Flow - only in the true lumen and that SEC is apparent in the false lumen. The true lumen also expands markedly during systole

In this longitudinal view through the distal aortic arch, the flap of a Stanford type 'A' dissection is demonstrated

distal descending thoracic aorta, occlusion of the false lumen of a Stanford type 'A' dissection by fresh thrombus is demonstrated.

Behandeling Aorta dissectie

Approximately 95% of dissections involve either ascending or

descending aorta whereas less than 5% involve the arch or abdominal aorta.
Both management and long term outcome are different for type A

and B dissections.
Given the high risk of spontaneous fatal rupture in type A (~90%),

surgery forms the mainstay of treatment for these cases,

whereas surgery confers no advantage over medical management in

uncomplicated type B dissections, with a reported 5 year survival of 75% irrespective of medical or surgical management.

Behandeling aneurysma aorta asc

Behandeling aneurysma Ao Desc.

Aortic atheroma
distal aortic arch, a pedunculated plaque

Atheroma scoring
Various atheroma scoring systems have been suggested. A system recently

used by Wilson et al is:

1. Normal 2. Intimal thickening (> 2 mm) 3. Atheroma < 4 mm +/- Ca++ 4. Atheroma >= 4 mm +/- Ca++, 5. Any size mobile or ulcerated lesion +/- Ca++.

Atheroma scoring
This is very similar to the grading system advocated by

Montgomery et al which is also widely used:

1. normal

2. intimal thickening
3. atheroma < 5 mm 4. atheroma > or = 5 mm 5. mobile lesion

Spontaneous Echo Contrast (Aortic)

Spontaneous Echo Contrast (Aorta)

SEC-atria in those in atrial fibrillation. However, it can also be found in

other parts of the circulation including the ventricles and the aorta.
In the aorta - low cardiac output or aortic pathology such as aneurysm,

dissection or marked atherosclerosis.

The presence of SEC - erythrocytic rouleaux formation in the setting of

stagnation of blood flow or the presence of rheological factors such as the presence of an anti-cardiolipin antibody, an elevation of the erythrocyte sedimentation rate, an increase in the level of plasma fibrinogen, or a high blood viscosity.
The important clinical correlates of aortic SEC : atrial fibrillation,

peripheral embolism, stroke and transient ischaemic attack.

Descending Aortic Flow (Aortic Incompetence