title: Ascending aortic elongation and the risk of dissection.
abstract: OBJECTIVE
  Unlike aneurysm formation, the role of ascending aortic elongation in the pathogenesis of Type A aortic dissection (TAD) is largely unclear. We investigated the morphology of healthy, dissected and predissection aortas with a focus on ascending aortic length.
  
  
  METHODS
  We retrospectively compared clinical and computer tomography angiography (CTA) data from TAD patients (n = 130), patients who developed a TAD in the further clinical course (preTAD, n = 16) and healthy control patients who received a CTA for non-aortic emergencies (n = 165). The length of the ascending aorta was defined as the distance between the sinotubular junction (STJ) and the brachiocephalic trunk (BCT) at the central line, the outer and inner curvature as well as the direct distance in the frontal and sagittal planes. Additionally, the aortic diameters were analysed.
  
  
  RESULTS
  In the healthy controls, we found a positive correlation of age with the aortic diameter (r = 0.57) and aortic length (r = 0.42). The correlation of the respective parameters with the body size was negligible (r < 0.2). The median ascending aortic diameter at the height of the pulmonary artery in TAD (50 mm) was significantly (P < 0.001) larger compared with the respective diameter of the healthy aortas (34 mm). The diameter of the preTAD aortas (40 mm) was also significantly larger compared with the healthy controls. These proportions were similar in all the aortic diameters. The midline length of the healthy ascending aortas was 71 mm. In the preTAD and TAD aortas, the same values were 81 mm and 92 mm, respectively (both P < 0.001). We evaluated the linear distance between the STJ and the BCT in the frontal plane as an easy-to-measure parameter of aortic length. In the TAD aortas (108 mm) and preTAD aortas (97 mm), this distance was significantly longer compared with the healthy aortas (84 mm).
  
  
  CONCLUSIONS
  Aortic diameter might not be an optimal parameter to predict dissection. Most aortas dissect at diameters below 55 mm. Both the TAD and preTAD aortas were elongated compared with the healthy controls. Thus, aortic elongation may play a role in the pathogenesis of and may be a risk factor for TAD.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany krueger-tobias@web.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Krüger
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Oksana
authors.initials: O
authors.lastname: Forkavets
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Kujtim
authors.initials: K
authors.lastname: Veseli
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Lausberg
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Luise
authors.initials: L
authors.lastname: Vöhringer
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Wilke
authors.initials: W
authors.lastname: Schneider
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis*; D001027:Aortography; D000072226:Computed Tomography Angiography / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Aneurysm; Aorta; Aortic dissection; Aortic elongation; Computed tomography