Abstract：
The most common reason for ascending aorta resection is an aneurysm or dissection. Aortic dissection is a life-threatening condition in which an aneurysm is a crucial risk factor. The essential criteria for aneurysm resection include the diameter, genetic predisposition, and aortic valve disease. This study aimed to compare the histological findings in aneurysms and dissections and correlate them with clinical parameters to determine whether histopathological findings correspond with the current clinical approach. A total of 160 ascending aorta surgical specimens, separate or with an aortic valve, were collected and divided into four groups: aneurysm-tricuspid (n = 40; median 67 y), aneurysm-malformed (n = 68; median 50 y), dissection-tricuspid (n = 48; median 65.5 y), and dissection-malformed (n = 4; median 52.5 y). Male preponderance was observed in all groups; the youngest patients were in the aneurysm-malformed group. None of the specimens showed normal aortic histology. The most common finding in the aortic samples was medial degeneration, which was the most severe and most common in dissection. The mildest findings were found in the aneurysm-malformed group. Atherosclerosis was predominant and most severe in the aneurysm-tricuspid group, while only mild in both dissection groups, suggesting its protective effect against this complication. Chronic aortitis was the least common pathology, found only in the aneurysm-tricuspid group. The aortic valve was resected and examined simultaneously with the ascending aorta in 76 cases, most commonly in the aneurysm-malformed group (n = 53). Myxoid degeneration was the major finding in the tricuspid aortic valves, with calcifications in the malformed. Comparing the histopathological results with the clinical aspects, aneurysms with a malformed aortic valve seem to be managed appropriately, with the findings not reaching the severity as in patients with a tricuspid valve. In contrast, in patients with a tricuspid valve, there were more dissections than aneurysms, with a significant subset of aneurysms showing histological findings almost identical to those of dissections. Supported by histological findings, patients with a diseased ascending aorta and tricuspid aortic valve represent an underdiagnosed risk group that would benefit from earlier diagnosis and intervention to prevent dissection. There is a need to find a marker for dissection risk other than the aortic diameter.
摘要：
升主动脉切除的最常见原因是动脉瘤或夹层。主动脉夹层是一种危及生命的疾病，其中动脉瘤是至关重要的危险因素。动脉瘤切除的基本标准包括直径，遗传易感性,和主动脉瓣疾病。这项研究旨在比较动脉瘤和夹层的组织学发现，并将其与临床参数相关联，以确定组织病理学发现是否与当前的临床方法相符。共有160例升主动脉手术标本,独立或带有主动脉瓣，收集并分为四组：动脉瘤-三尖瓣(n=40；中位数67岁)，动脉瘤畸形（n=68；中位数50y），三尖瓣夹层（n=48；中位数65.5y），解剖畸形（n=4；中位数52.5y）。在所有组中都观察到男性优势；最年轻的患者是动脉瘤畸形组。没有一个标本显示正常的主动脉组织学。主动脉样本中最常见的发现是内侧变性，这是最严重和最常见的解剖。在动脉瘤畸形组中发现了最温和的发现。动脉瘤-三尖瓣组中动脉粥样硬化占优势，最严重，虽然在两个解剖组中都只有轻微的，表明其对这种并发症的保护作用。慢性主动脉炎是最不常见的病理,仅在动脉瘤-三尖瓣组中发现。76例切除主动脉瓣并与升主动脉同时检查。最常见于动脉瘤畸形组(n=53)。黏液样变性是三尖瓣主动脉瓣的主要发现，钙化畸形。将组织病理学结果与临床方面进行比较，主动脉瓣畸形的动脉瘤似乎得到了适当的治疗，结果没有达到三尖瓣患者的严重程度。相比之下,患有三尖瓣的患者，夹层比动脉瘤多，有相当一部分动脉瘤的组织学发现与夹层几乎相同。在组织学发现的支持下，升主动脉和三尖瓣主动脉瓣病变患者是未被诊断的危险人群,可从早期诊断和预防夹层的干预措施中获益.需要找到除主动脉直径以外的夹层风险标志物。
