aorta2.pptx

8/14/2019 aorta2.pptx

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AortaRAMA


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Aorta

Anatomie

Aorta afmetingen

Aneurysma

Dissectie

Behandeling

Atheroma

SEC

Echo beeld in AI

Congenitale afwijkingen


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Aorta afmeting-waarom???


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Anatomie


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Anatomie aorta ascendens


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echocardiography. The aortic diameter measured at the aortic annulus (1), the sinuses of

Valsalva (2), the supra-aortic ridge (3), and the proximal ascending aorta (4). In Marfan

syndrome, dilatation usually starts at the sinuses of Valsalva, so this measurement is critical in

monitoring the early evolution of the condition. Diameters must be related to normal values for

age and body surface area.


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Aorta dimensies-TEE

Cohen et al made various cardiac measurements using transoesophagealechocardiography in a group of 60 normal adults. These authors found thefollowing aortic dimensions:

Aortic Annulus 1.4 - 2.6 cms

Tran-sinus 2.1 - 3.5 cms

Sino-tubular junction 1.7 - 3.4 cms

Ascending aorta 2.1 - 3.4 cms

Aortic arch 2.0 - 3.6 cms

Area 2.4 - 3.5 cms^2


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Aorta dimensies-Ctscan

Hager et al who have reported the diameter of the thoracicaorta at various sites as measured by helical computedtomography. In a group of 70 normal adults, these authorsreported the following aortic dimensions:

Tran-sinus 2.98 +/- 0.46 cms

Ascending aorta 3.09 +/- 0.41 cms

Distal Aortic arch 2.47 +/- 0.40 cms

Diaphragm 2.43 +/- 0.35 cms


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Beperking van echo cor:

Beperkte zicht op proxaorta


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C shape van aorta

Metingen van diameter CT

scan niet altijd accuraat


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Axiale beelden van ctscan

Diameter van proximale aorta

moeilijk te meten door

bochtige/ geelongeerde aorta


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Loss of Normal "Waist" at

Sinotubular Junction: ASign of Intrinsic AorticDisease

A-normaal

B-abnormal aorticcontour (with no "waist")of Marfan-likeannuloaortic ectasia


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Diameter sinus van valsalva

Which Is the True "Diameter? Geometric complexity of

measuring aortic diameter


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Aortic Size Index Nomogram


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Depiction of "Hinge Points" for Lifetime Natural History Complications atVarious Sizes of the Aorta

The y-axis lists the probability of complication; complication refers torupture or dissection

Di ti D O t S ll


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Dissections Do Occur at SmallSizes

Distribution of aortic size at the time of presentation with acute type A

aortic dissection


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Survival With Thoracic Aneurysms of Various SizesFive-year hazard estimates are illustrated for patients as a function of

initial aneurysm size


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That Acute Aortic DissectionOccurs Is Not Random"


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Pt:Ascending Aortic Aneurysm


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ascending aortic aneurysm

aneurysm was associated with marked dilatation of theaortic annulus such that the annular diameter was 3.8 cms(normal range:1.4 - 2.6 cms).

This dilatation was associated with severe aorticincompetence.

Further 2D examination of the valve demonstrated

completely normal leaflet morphology. Note also, the complete effacement of the sino-tubular

junction.


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ascending aortic aneurysm

This patient was a young man. In such cases,

Marfan's and

Ehlers-Danlos' syndrome and the presence of

a Bicuspid Aortic Valve (BAV) are recognised as specific risk factors for aneurysmformation.

The genetic basis for

Marfan syndrome is now well-accepted as being a mutation in the gene for fibrillin-1

and

the Ehlers-Danlos syndrome is believed to result from mutations in the gene fortype III procollagen (COL3A1).

There is a strong relationship between the presence of a BAV and the development of

ascending aortic aneurysm - even in the absence of aortic stenosis. This has been

attributed to the presence of significant histological abnormalities in the aortic wall of

patients with BAV (Matthias Bechtel et al).


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Ziekte van marfan

autosomal dominant disorder, characteristically with cardiovascular, eye andskeletal, features.

The minimal birth incidence is 1 in 9800

27% of cases arise from new mutation

Mutation in fibrillin-1 on chromosome 15 is detected in 6691% of cases

Some cases may be due to mutation in TGFbetaRl or TGFbetaR2

TGFbetaR1 or TGFbetaR2 are also associated with Loeys-Dietz syndrome, andTGFbetaR2 with familial thoracic aortic aneurysm

The clinical diagnosis in adults should be made using the Ghent criteria

Prophylactic medical treatment to protect the aorta with regular follow-up helpsprevent or delay serious complications

Prophylactic aortic surgery when the aortic root at the Sinus of Valsalva exceeds 5

cm


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Aorta dissectie


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Aortic Dissection (Ascending)


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Type B dissectie


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classification

DEBAKEY:

1. Dissection involving the ascending and descending aorta and aortic arch (10 %).

2. Dissection involving only the ascending aorta and aortic arch (60%).

3. Dissection involving only the descending aorta only (30 % ).

STANFORD:

'A'. Debakey types 1 and 2: i.e. involves the ascending aorta.

'B'. Debakey type 3: i.e. involves only the descending aorta.

Although anatomically more specific than the Stanford classification, the Debakeysystem seems to be less-widely used and less clinically useful than the Stanfordclassification.


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.

Flow - only in the true lumen and that SEC is apparent in the false lumen. The truelumen also expands markedly during systole


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In this longitudinal view through the distal aortic arch, the flap of a

Stanford type 'A' dissection is demonstrated.


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distal descending thoracic aorta, occlusion of the false lumen of aStanford type 'A' dissection by fresh thrombus is demonstrated.


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Behandeling Aorta dissectie

Approximately 95% of dissections involve either ascending ordescending aorta whereas less than 5% involve the arch or abdominalaorta.

Both management and long term outcome are different for type Aand B dissections.

Given the high risk of spontaneous fatal rupture in type A (~90%),surgery forms the mainstay of treatment for these cases,

whereas surgery confers no advantage over medical management inuncomplicated type B dissections, with a reported 5 year survival of75% irrespective of medical or surgical management.


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Behandeling aneurysma aorta asc


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Aortic atheromadistal aortic arch, a pedunculated plaque


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Atheroma scoring

Various atheroma scoring systems have been suggested. A system recentlyused by Wilson et al is:

1. Normal

2. Intimal thickening (> 2 mm)

3. Atheroma < 4 mm +/- Ca++

4. Atheroma >= 4 mm +/- Ca++,

5. Any size mobile or ulcerated lesion +/- Ca++.


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S E h C


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Spontaneous Echo Contrast(Aortic)

Spontaneous Echo Contrast


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Spontaneous Echo Contrast(Aorta)

SEC-atria in those in atrial fibrillation. However, it can also be found inother parts of the circulation including the ventricles and the aorta.

In the aorta - low cardiac output or aortic pathology such as aneurysm,dissection or marked atherosclerosis.

The presence of SEC - erythrocytic rouleaux formation in the setting ofstagnation of blood flow or the presence of rheological factors such asthe presence of an anti-cardiolipin antibody, an elevation of theerythrocyte sedimentation rate, an increase in the level of plasmafibrinogen, or a high blood viscosity.

The important clinical correlates of aortic SEC : atrial fibrillation,peripheral embolism, stroke and transient ischaemic attack.

D di A ti Fl (A ti


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Descending Aortic Flow (AorticIncompetence


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aorta2.pptx

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