Variation in the histopathological features of patients with ascending aortic aneurysms: a study of 111 surgically excised cases.

Abstract

BACKGROUND:

Ascending aortic aneurysms (AA) are a common, though poorly understood medical condition.

AIMS:

To document the histological changes in a large series of human ascending AA, and to correlate these changes with clinical variables.

METHODS:

111 ascending AA were excised at surgery over a 3 year period. Each aneurysm was received as a continuous ring of tissue. Sections were taken from the anterior, posterior, greater and lesser curvature of the aorta and graded in a semi-quantitative fashion for the degree of elastin fragmentation, elastin loss, smooth muscle cell (SMC) loss, intimal changes and inflammation.

RESULTS:

Mean patient age at surgery was 58.7 (15.6) years; there were 70 men and 41 women. 12 patients had Marfan syndrome, 34 (30.6%) had a bicuspid aortic valve (BAV), while 71 (64.0%) had a tricuspid aortic valve (TAV). Inflammatory cells were present in 28 cases (25.2%) and were confined to the adventitia. No particular region of the aortic circumference was more severely affected, however a BAV was associated with significantly less intimal change, and less fragmentation and loss of elastic tissue compared with patients with a TAV. Advanced age (>65 years), female gender and Marfan syndrome were all associated with more severe elastin degeneration and smooth muscle cell loss (p<0.05 for all).

CONCLUSION:

Results indicate a wide variation in the histological appearance in ascending AA, depending on patient characteristics. They suggest that the underlying aneurysm pathogenesis may also be highly variable; this warrants further investigation.

• Authors: M J Collins, V Dev, B H Strauss, P W M Fedak, J Butany
• Journal: Journal of clinical pathology (J Clin Pathol) Vol. 61 Issue 4 Pg. 519-23 (Apr 2008) ISSN: 1472-4146 [Electronic] England
• PMID: 17938162 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Elastin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aortic Aneurysm (metabolism, pathology, surgery)
• Aortic Valve (abnormalities)
• Elastic Tissue (pathology)
• Elastin (analysis)
• Female
• Humans
• Male
• Marfan Syndrome (metabolism, pathology)
• Middle Aged
• Muscle, Smooth, Vascular (pathology)
• Sex Factors
• Tunica Intima (pathology)