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Variation in the histopathological features of patients with ascending aortic aneurysms: a study of 111 surgically excised cases.
  1. Michael J. Collins
  1. Department of Pathology, Toronto General Hospital, Canada
    1. Varun Dev
    1. Department of Pathology, Toronto General Hospital, Canada
      1. Bradley H. Strauss
      1. Department of Cardiology, St. Michael’s Hospita, Canada
        1. Paul W.M. Fedak
        1. Division of Cardiac Surgery, Toronto General Hospital, Canada
          1. Jagdish Butany (jadish.butany{at}
          1. Department of Pathology, Toronto General Hospital, Canada


            Introduction: Ascending aortic aneurysms (AA) are a common, though poorly understood medical condition. In the present study we aim to document the histologic changes in a large series of human ascending AA, and to correlate these changes with clinical variables. Methods: 111 ascending AA were excised at surgery at our institution over a 3 year period. Each aneurysm was received as a continuous ring of tissue. Sections were taken from the anterior, posterior, greater and lesser curvature of the aorta and graded in a semiquantitative fashion for the degree of elastin fragmentation, elastin loss, smooth muscle cell (SMC) loss, intimal changes and inflammation. Results: Mean patient age at surgery was 58.7+/-15.6 years. There were 70 males and 41 females, 12 patients had Marfan syndrome, 34 (30.6%) had a bicuspid aortic valve (BAV) while 71 (64.0%) had a tricuspid aortic valve (TAV). Inflammatory cells were present in 28 cases (25.2%) and were confined to the adventitia. No particular region of the aortic circumference was more severely affected, however a BAV was associated with significantly less intimal change and less fragmentation and loss of elastic tissue compared with patients with a TAV. Advanced age (>65 years), female gender and Marfan syndrome were all associated with more severe elastin degeneration and smooth muscle cell loss (p<0.05 for all). Conclusion: These results indicate a wide variation in the histological appearance in ascending AA depending on patient characteristics. These results suggest that the underlying aneurysm pathogenesis may also be highly variable and warrants further investigation.

            • aneurysm pathogenesis
            • aortic aneurysm
            • bicuspid aortic valve
            • histology

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