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A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation

(1) Background: The pathophysiologic basis of an acute type A aortic dissection (TAAD) is largely unknown. In an effort to evaluate vessel wall defects, we systematically studied aortic specimens in TAAD patients. (2) Methods: Ascending aortic wall specimens (n = 58, mean age 63 years) with TAAD wer...

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Autores principales: Grewal, Nimrat, Velders, Bart J. J., Gittenberger-de Groot, Adriana C., Poelmann, Robert, Klautz, Robert J. M., Van Brakel, Thomas J., Lindeman, Jan H. N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911401/
https://www.ncbi.nlm.nih.gov/pubmed/33513898
http://dx.doi.org/10.3390/jcdd8020012
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author Grewal, Nimrat
Velders, Bart J. J.
Gittenberger-de Groot, Adriana C.
Poelmann, Robert
Klautz, Robert J. M.
Van Brakel, Thomas J.
Lindeman, Jan H. N.
author_facet Grewal, Nimrat
Velders, Bart J. J.
Gittenberger-de Groot, Adriana C.
Poelmann, Robert
Klautz, Robert J. M.
Van Brakel, Thomas J.
Lindeman, Jan H. N.
author_sort Grewal, Nimrat
collection PubMed
description (1) Background: The pathophysiologic basis of an acute type A aortic dissection (TAAD) is largely unknown. In an effort to evaluate vessel wall defects, we systematically studied aortic specimens in TAAD patients. (2) Methods: Ascending aortic wall specimens (n = 58, mean age 63 years) with TAAD were collected. Autopsy tissues (n = 17, mean age 63 years) served as controls. All sections were studied histopathologically. (3) Results: Pathomorphology in TAAD showed predominantly moderate elastic fiber fragmentation/loss, elastic fiber thinning, elastic fiber degeneration, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration. The control group showed significantly fewer signs of those histopathological features (none-mild, p = 0.00). It was concluded that the dissection plane consistently coincides with the vasa vasorum network, and that TAAD associates with a significantly thinner intimal layer p = 0.005). (4) Conclusions: On the basis of the systematic evaluation and the consistent presence of diffuse, pre-existing medial defects, we hypothesize that TAAD relates to a developmental defect of the ascending aorta and is caused by a triple-hit mechanism that involves (I) an intimal tear; and (II) a diseased media, which allows (III) propagation of the tear towards the plane of the vasa vasorum where the dissection further progresses.
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spelling pubmed-79114012021-02-28 A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation Grewal, Nimrat Velders, Bart J. J. Gittenberger-de Groot, Adriana C. Poelmann, Robert Klautz, Robert J. M. Van Brakel, Thomas J. Lindeman, Jan H. N. J Cardiovasc Dev Dis Article (1) Background: The pathophysiologic basis of an acute type A aortic dissection (TAAD) is largely unknown. In an effort to evaluate vessel wall defects, we systematically studied aortic specimens in TAAD patients. (2) Methods: Ascending aortic wall specimens (n = 58, mean age 63 years) with TAAD were collected. Autopsy tissues (n = 17, mean age 63 years) served as controls. All sections were studied histopathologically. (3) Results: Pathomorphology in TAAD showed predominantly moderate elastic fiber fragmentation/loss, elastic fiber thinning, elastic fiber degeneration, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration. The control group showed significantly fewer signs of those histopathological features (none-mild, p = 0.00). It was concluded that the dissection plane consistently coincides with the vasa vasorum network, and that TAAD associates with a significantly thinner intimal layer p = 0.005). (4) Conclusions: On the basis of the systematic evaluation and the consistent presence of diffuse, pre-existing medial defects, we hypothesize that TAAD relates to a developmental defect of the ascending aorta and is caused by a triple-hit mechanism that involves (I) an intimal tear; and (II) a diseased media, which allows (III) propagation of the tear towards the plane of the vasa vasorum where the dissection further progresses. MDPI 2021-01-27 /pmc/articles/PMC7911401/ /pubmed/33513898 http://dx.doi.org/10.3390/jcdd8020012 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Grewal, Nimrat
Velders, Bart J. J.
Gittenberger-de Groot, Adriana C.
Poelmann, Robert
Klautz, Robert J. M.
Van Brakel, Thomas J.
Lindeman, Jan H. N.
A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
title A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
title_full A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
title_fullStr A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
title_full_unstemmed A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
title_short A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
title_sort systematic histopathologic evaluation of type-a aortic dissections implies a uniform multiple-hit causation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911401/
https://www.ncbi.nlm.nih.gov/pubmed/33513898
http://dx.doi.org/10.3390/jcdd8020012
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