title: Gender-specific differences in aortic sinus curvature during aging: an anatomical and computational study.
abstract: BACKGROUND
  Our goal was to investigate the potential impact of aortic sinus wall curvature on the risk for type A aortic dissection.
  
  
  METHODS
  We measured the curvature and carried out histological tests of the aortic noncoronary sinus in 46 patients who did not die from cardiac disease. Based on observed curvature values, we investigated the mechanical stress in the aortic root using finite element analysis.
  
  
  RESULTS
  Sinus curvature was found to experience a more than fourfold increase with age in males and reached the higher, age-independent values measured in females by age 65. The histological tests revealed that degenerative alterations did not significantly increase with aging in either gender, although fibrosis did in older women. Finite element analysis illustrated that the risk for a circumferential tear to occur was smallest when sinus curvature was highest.
  
  
  CONCLUSIONS
  We established significant gender-specific disparities in the aortic root during aging: while aortic sinus curvature was high in females throughout their lives, it experienced a more than fourfold increase in the lifetime of males, matching values in females only by age 65. Our mechanical analyses confirmed the overall potential protective role of higher sinus wall curvature with respect to type A aortic dissection, and geometry alone could not account for the known gender difference in aortic dissection prevalence.
authors.affiliation: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Carsten J
authors.initials: CJ
authors.lastname: Beller
authors.forename: Tilman
authors.initials: T
authors.lastname: Maurer
authors.forename: Michel R
authors.initials: MR
authors.lastname: Labrosse
authors.forename: Thierry
authors.initials: T
authors.lastname: Mesana
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: John P
authors.initials: JP
authors.lastname: Veinot
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D000784:Aortic Dissection / Q000209:etiology* / Q000473:pathology; D001014:Aortic Aneurysm / Q000209:etiology* / Q000473:pathology; D001344:Autopsy; D003198:Computer Simulation; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012850:Sinus of Valsalva / Q000473:pathology*; D013314:Stress, Mechanical