A Systematic Histopathologic Evaluation of Type-A Aortic Dissections Implies a Uniform Multiple-Hit Causation
Journal of Cardiovascular Development and Disease, vol. 8, pp. 12
Abstract
(1) Background: The pathophysiologic basis of an acute type A aortic dissection (TAAD) is largely unknown. In an effort to evaluate vessel wall defects, we systematically studied aortic specimens in TAAD patients. (2) Methods: Ascending aortic wall specimens (n = 58, mean age 63 years) with TAAD were collected. Autopsy tissues (n = 17, mean age 63 years) served as controls. All sections were studied histopathologically. (3) Results: Pathomorphology in TAAD showed predominantly moderate elastic fiber fragmentation/loss, elastic fiber thinning, elastic fiber degeneration, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration. The control group showed significantly fewer signs of those histopathological features (none-mild, p = 0.00). It was concluded that the dissection plane consistently coincides with the vasa vasorum network, and that TAAD associates with a significantly thinner intimal layer p = 0.005). (4) Conclusions: On the basis of the systematic evaluation and the consistent presence of diffuse, pre-existing medial defects, we hypothesize that TAAD relates to a developmental defect of the ascending aorta and is caused by a triple-hit mechanism that involves (I) an intimal tear; and (II) a diseased media, which allows (III) propagation of the tear towards the plane of the vasa vasorum where the dissection further progresses.
Authors 7
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Nimrat Grewal corresponding Aachen Department of Anatomy and Embryology Department of Cardiothoracic Surgery
Leiden University Medical Center
Affiliation as printed
Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Adriana C. Gittenberger–de Groot Aachen Department of Anatomy and Embryology Department of Cardiology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Anatomy and Embryology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Affiliation as printed
Institute of Biology, Animal Sciences and Health, Leiden University, 2333 BE Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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