Ascending aortic curvature as an independent risk factor for type A dissection, and ascending aortic aneurysm formation: a mathematical model.
OBJECTIVE
To develop a mathematical model to demonstrate that ascending aortic curvature is an independent risk factor for type A dissections, in addition to hypertension, bicuspid aortic valve, aneurysm of ascending aorta, and intrinsic aortic tissue abnormalities, like Marfan's syndrome.


METHODS
A steady state one-dimensional flow analysis was performed, utilising Newton's third law of motion. Five different clinical scenarios were evaluated: (1) effect of aortic curvature; (2) effect of beta-blockers, (3) effect of patient size, (4) forces on a Marfan's aorta, and (5) site of entry flap in aortic dissection.


RESULTS
Aortic curvature increases the forces exerted on the ascending aorta by a factor of over 10-fold. Aortic curvature can cause patients with a systolic blood pressure of 8 0mmHg to have greater forces exerted on their aorta despite smaller diameters and lower cardiac outputs, than patients with systolic blood pressures of 120 mmHg. In normal diameter aortas, beta-blockers have minimal effect compared with aortic curvature. Aortic curvature may help to explain why normal diameter aortas can dissect, and also that the point of the entry tear may be potentially predictable. Aortic curvature has major effects on the forces exerted on the aorta in patients with Marfan's syndrome.


CONCLUSIONS
Aortic curvature is relatively more important that aortic diameter, blood pressure, cardiac output, beta-blocker use, and patient size with regard to the force acting on the aortic wall. This may explain why some patients with normal diameter ascending aortas with or without Marfan's syndrome develop type A dissections and aneurysms. Aortic curvature may also help to explain the site of entry tear in acute type A dissection. Further clinical study is needed to validate this study's finding.
Poullis
Michael P
MP
Department of Cardiothoracic Surgery, Thomas Drive, Liverpool L14 3PE, United Kingdom. mike.poullis@ctc.nhs.uk
Warwick
Richard
R
Oo
Aung
A
Poole
Robert J
RJ
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D001011:Aorta / Q000187:drug effects / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D001027:Aortography; D001794:Blood Pressure; D001835:Body Weight; D002302:Cardiac Output; D018056:Hemorheology; D006801:Humans; D008382:Marfan Syndrome / Q000503:physiopathology; D008955:Models, Cardiovascular; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D000319:Adrenergic beta-Antagonists