Key result
Aneurysmal aortic root and proximal ascending aorta tissues showed significantly increased medial fibrosis and collagen density compared to non-aneurysmal tissue.
Why the study?
Aortic root and ascending aortic aneurysms are treated identically despite differing in embryological development and pathological processes.
Observational (n=21)
No
p-value: p=<0.005
Aortic root aneurysms exhibit distinct histological features, including increased collagen I deposition and fibrosis in sinus regions, suggesting a unique pathophysiological process compared to ascending aortic aneurysms.
Increased medial fibrosis in aneurysmal aortas may refine imaging surveillance; leaves open whether fibrosis drives progression or is a secondary response.
Background Although aortic root and ascending aortic aneurysms are treated the same, they differ in embryological development and pathological processes. This study examines the microscopic structural differences between aortic root and ascending aortic aneurysms, correlating these features to the macroscopic pathophysiological processes. Methods We obtained surgical samples from ascending aortic aneurysms (n=11), aortic root aneurysms (n=3), and non-aneurysmal patients (n=7), Aortic collagen and elastin content were examined via histological analysis, and immunohistochemistry techniques used to determine collagen I, III, and IV subtypes. Analysis was via observational features, and colour deconvolution quantification techniques. Results Elastin fiber disruption and fragmentation was the most extensive in the proximal aneurysmal regions. Medial fibrosis and collagen density increased in proximal aneurysmal regions and aortic root aneurysms (p<0.005). Collagen I was seen in highest quantity in aortic root aneurysms. Collagen I content was greatest in the sinus tissue regions compared to the valvular and ostial regions (p<0.005) Collagen III and IV quantification did not vary greatly. The most susceptible regions to ultrastructural changes in disease are the proximal ascending aorta and aortic root. Conclusions The aortic root differs histologically from the ascending aorta confirming its unique composition in aneurysm pathology. These findings should prompt further evaluation on the influence of this altered structure on function which could potentially guide clinical management.
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Surman et al. (2021) conducted an observational in Aortic root and ascending aortic aneurysms (n=21). Aneurysmal aortic tissue (ascending and root) vs. Non-aneurysmal aortic tissue was evaluated on Medial fibrosis and collagen density (p=<0.005). Aneurysmal aortic root and proximal ascending aorta tissues showed significantly increased medial fibrosis and collagen density compared to non-aneurysmal tissue.
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