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Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review
OBJECTIVE: This review aims to synthesize the existing knowledge on the etiological process leading to type A aortic dissection (TAAD) and to clarify the relationship between mechanical, biochemical, and histopathological processes behind the aortic disease. BACKGROUND: Extensive research has previo...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575841/ https://www.ncbi.nlm.nih.gov/pubmed/34795949 http://dx.doi.org/10.21037/jtd-21-829 |
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author | Uimonen, Mikko |
author_facet | Uimonen, Mikko |
author_sort | Uimonen, Mikko |
collection | PubMed |
description | OBJECTIVE: This review aims to synthesize the existing knowledge on the etiological process leading to type A aortic dissection (TAAD) and to clarify the relationship between mechanical, biochemical, and histopathological processes behind the aortic disease. BACKGROUND: Extensive research has previously identified several risk factors for TAAD as well as pathological mechanisms leading to TAAD. However, due to the complexity of the pathological process and limited knowledge on the relationships between distinct pathomechanisms leading to TAAD, the ability to identify the patients at high risk for TAAD has been poor. METHODS: PubMed (National Library of Medicine) database was searched for suitable literature. The most relevant articles focusing on anatomy, histopathology, physiology, and mechanics of ascending aorta and aortic diseases were reviewed. CONCLUSIONS: Pathophysiology of the TAAD is related to biochemical and histological as well as mechanical and hemodynamic alterations leading to a degeneration of the aortic wall via inflammatory response. The degradative mechanisms of aortic wall structures and the mechanical forces, to which the wall is predisposed, are interrelated and influence one another. The relativity between the factors influencing aortic wall strength and healing capacity, and factors influencing mechanical stress on the aortic wall suggest that the risk of TAAD is not a linear but rather a dynamic phenomenon. Accounting for the dynamical property of the aortic disease in assessing the need for preventive surgical aortic reconstruction may provide a wider perspective in identifying patients at risk of TAAD and in planning preventive medical therapies. |
format | Online Article Text |
id | pubmed-8575841 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-85758412021-11-17 Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review Uimonen, Mikko J Thorac Dis Review Article OBJECTIVE: This review aims to synthesize the existing knowledge on the etiological process leading to type A aortic dissection (TAAD) and to clarify the relationship between mechanical, biochemical, and histopathological processes behind the aortic disease. BACKGROUND: Extensive research has previously identified several risk factors for TAAD as well as pathological mechanisms leading to TAAD. However, due to the complexity of the pathological process and limited knowledge on the relationships between distinct pathomechanisms leading to TAAD, the ability to identify the patients at high risk for TAAD has been poor. METHODS: PubMed (National Library of Medicine) database was searched for suitable literature. The most relevant articles focusing on anatomy, histopathology, physiology, and mechanics of ascending aorta and aortic diseases were reviewed. CONCLUSIONS: Pathophysiology of the TAAD is related to biochemical and histological as well as mechanical and hemodynamic alterations leading to a degeneration of the aortic wall via inflammatory response. The degradative mechanisms of aortic wall structures and the mechanical forces, to which the wall is predisposed, are interrelated and influence one another. The relativity between the factors influencing aortic wall strength and healing capacity, and factors influencing mechanical stress on the aortic wall suggest that the risk of TAAD is not a linear but rather a dynamic phenomenon. Accounting for the dynamical property of the aortic disease in assessing the need for preventive surgical aortic reconstruction may provide a wider perspective in identifying patients at risk of TAAD and in planning preventive medical therapies. AME Publishing Company 2021-10 /pmc/articles/PMC8575841/ /pubmed/34795949 http://dx.doi.org/10.21037/jtd-21-829 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Review Article Uimonen, Mikko Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review |
title | Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review |
title_full | Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review |
title_fullStr | Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review |
title_full_unstemmed | Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review |
title_short | Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review |
title_sort | synthesis of multidimensional pathophysiological process leading to type a aortic dissection: a narrative review |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575841/ https://www.ncbi.nlm.nih.gov/pubmed/34795949 http://dx.doi.org/10.21037/jtd-21-829 |
work_keys_str_mv | AT uimonenmikko synthesisofmultidimensionalpathophysiologicalprocessleadingtotypeaaorticdissectionanarrativereview |