title: How does the ascending aorta geometry change when it dissects?
abstract: OBJECTIVE
  The purpose of this study is to delineate changes in aortic geometry and diameter due to dissection.
  
  
  BACKGROUND
  Aortic diameter is the major criterion for elective ascending aortic replacement for dilated ascending aortas to prevent aortic dissection. However, recommendations are made on the basis of clinical experience and observation of diameters of previously dissected aortas.
  
  
  METHODS
  Six tertiary centers on 2 continents reviewed their acute aortic dissection type A databases, which contained 1,821 patients. Included were all non-Marfan patients with nonbicuspid aortic valves who had undergone computed tomography angiography <2 years before and within 12 h after aortic dissection onset. Aortic geometry before and after dissection onset were compared.
  
  
  RESULTS
  Altogether, 63 patients were included (27 spontaneous and 36 retrograde dissections, median age 68 [57; 77] years; 54% were men). In all but 1 patient, maximum ascending aortic diameter was <55 mm before aortic dissection onset. The largest increase in diameter and volume induced by the dissection were observed in the ascending aorta (40.1 [36.6; 45.3] mm vs. 52.9 [46.1; 58.6] mm, +12.8 mm; p < 0.001; 124.0 [90.8; 162.5] cm(3) vs. 171.0 [147.0; 197.0] cm(3), +47 cm(3); p < 0.001). Mean aortic arch diameter increased from 39.8 (30.5; 42.6) mm to 46.4 (42.0; 51.6) mm (+6.6 mm; p < 0.001) and descending thoracic aorta diameter from 31.2 (27.0; 33.3) mm to 34.9 (30.9; 39.5) mm (+3.7 mm; p < 0.001). Changes in thoracic aorta geometry were similar for spontaneous and retrograde etiology.
  
  
  CONCLUSIONS
  Geometry of the thoracic aorta is affected by aortic dissection, leading to an increase in diameter that is most pronounced in the ascending aorta. Both spontaneous and retrograde dissection result in similar aortic geometry changes.
authors: Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany. Electronic address: bartosz.rylski@universitaets-herzzentrum.de.
authors: Bartosz
authors: B
authors: Rylski
authors: Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
authors: Philipp
authors: P
authors: Blanke
authors: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors: Friedhelm
authors: F
authors: Beyersdorf
authors: Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Nimesh D
authors: ND
authors: Desai
authors: Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Rita K
authors: RK
authors: Milewski
authors: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors: Matthias
authors: M
authors: Siepe
authors: Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany.
authors: Fabian A
authors: FA
authors: Kari
authors: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors: Martin
authors: M
authors: Czerny
authors: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors: Thierry
authors: T
authors: Carrel
authors: Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany.
authors: Christian
authors: C
authors: Schlensak
authors: Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany.
authors: Tobias
authors: T
authors: Krüger
authors: Division of Cardiothoracic Surgery, Baylor Healthcare System, The Heart Hospital, Plano, Texas.
authors: Michael J
authors: MJ
authors: Mack
authors: Division of Cardiothoracic Surgery, Baylor Healthcare System, The Heart Hospital, Plano, Texas.
authors: William T
authors: WT
authors: Brinkman
authors: Department of Cardiac Surgery, Leipzig Heart Center-University of Leipzig, Leipzig, Germany.
authors: Friedrich W
authors: FW
authors: Mohr
authors: Department of Cardiac Surgery, Leipzig Heart Center-University of Leipzig, Leipzig, Germany.
authors: Christian D
authors: CD
authors: Etz
authors: Department of Cardiac Surgery, Leipzig Heart Center-University of Leipzig, Leipzig, Germany.
authors: Maximilian
authors: M
authors: Luehr
authors: Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Joseph E
authors: JE
authors: Bavaria
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: aorta; computed tomography; dissection; surgery