One of the methods of dealing with a dilated ascending aorta is to decrease its diameter using external wrapping. This exovascular procedure is regarded by many surgeons as controversial. The aim of the study was to evaluate the safety and efficacy of external wrapping of the ascending aorta. A metaanalysis and systematic review of studies reporting mid-term and long-term results of wrapping of the ascending aorta were performed. The postoperative hospital mortality, aortic-related mortality, significant redilatation rate, and need for aortic reoperation were analyzed. 17 manuscripts were included in the final analysis and postoperative data of 722 patients were studied. The mean age of patients was 58 years and mean follow-up was 62 months. Hospital mortality was 1.5% (11 deaths). During the follow-up late aortic related mortality was noted in two patients (0.3%), there were 12 (1.7%) cases of significant redilatation of the ascending aorta, and 13 (1.8%) patients had to have their ascending aorta reoperated. All of the aortic complications were noted in patients who either did not have their external wrapping sutured to the aorta or who underwent concomitant aortoplasty. The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.

Background There is evidence that advanced infectious chronic periodontal inflammatory disease may have an impact on general health including cardiovascular diseases. The aim of this clinical study was to evaluate the ability of Porphyromonas gingivalis to colonize heart valves and, subsequently, to assess whether there is an association between the presence of the DNA of Porphyromonas gingivalis in periodontal pockets and in degenerated heart valves.Materials and Methods Thirty patients were enrolled in the study and 31 valve specimens harvested during cardiac surgery operations were examined. All patients underwent a periodontal examination. To evaluate the periodontal status of the patients the following clinical parameters were recorded: the pocket depth, bleeding on probing (BOP) and aproximal plaque index (API). The presence of P. gingivalis in heart valve specimens and samples from periodontal pockets was analyzed using a single–step PCR method.ResultsP. gingivalis DNA was detected in periodontal p...

Biomechanical factors influence stress in the aortic wall. The aim of this study was to assess how the diameter and shape of the vessel, blood pressure and longitudinal systolic aortic stretching (SAS) caused by the contraction of the myocardium influence stress in the aortic wall. Three computational models of the non-dilated aorta and aneurysms of the ascending aorta and aortic root were created. Then, finite elements analyses were carried out. The models were subjected to blood pressure (120 mmHg and 160 mmHg) and longitudinal systolic aortic stretching (0 mm, 5 mm, 10 mm and 15 mm). The influence of wall elasticity was examined too. Blood pressure had a smaller impact on the stress than the SAS. An increase in blood pressure from 120 mmHg to 160 mmHg increased the peak wall stress (PWS) on average by 0.1 MPa in all models. A 5 mm SAS caused a 0.1–0.2 MPa increase in PWS in all the models. The increase in PWS caused by a 10 mm and 15 mm SAS was 0.2 MPa and 0.4 MPa in the non-dilated aorta, 0.2–0.3 MPa and 0.3–0.5 MPa in the aneurysm of the ascending aorta, and 0.1–0.2 MPa and 0.2–0.3 MPa in the aortic root aneurysm model, respectively. The loss of elasticity of the aneurysmal wall resulted in an increase of PWS by 0.1–0.2 MPa. Aortic geometry, wall stiffness, blood pressure and SAS have an impact on PWS. However, SAS had the biggest impact on wall stress. The results of this study may be useful in future patient-specific computational models used to assess the risk of aortic complications.

The stress in the ascending aorta results from many biomechanical factors including the geometry of the vessel and its maximum dimensions, arterial blood pressure and longitudinal systolic stretching due to heart motion. The stretching of the ascending aorta resulting from the longitudinal displacement of the aortic annulus during the heart cycle has not been examined in the general population so far. The aim of the study is to evaluate this parameter using cardiovascular magnetic resonance (CMR) imaging in the general population in all age groups. The cardiac magnetic resonance images of 73 patients were evaluated. The maximum distance to which the ventriculo-aortic junction was pulled by the contracting heart (LDAA – longitudinal displacement of the aortic annulus) was measured in the cine coronal sequences. Moreover, the maximum dimensions of the aortic root and the ascending aorta were assessed. The LDAA value was on average 11.6 ± 2.9 mm (range: 3-19 mm; 95% CI: 10.9–12.3 mm) and did not differ between males and females (11.8 ± 2.9 mm vs. 11.2 ± 2.9 mm, p = .408). The diameter of the ascending aorta was 32 ± 6.3 mm (range: 20-57 mm). The maximal dimension of the aortic root was 35 ± 5.1 mm (range: 18-42 mm). There was a statistically significant negative correlation between the LDAA and the age of patients (r = −.38, p = .001). There was no significant correlation between the LDAA and aortic root dimension (r = .1, p = .409) and between the LDAA and diameter of the ascending aorta (r = .16, p = .170). Human aortic root and ascending aorta are significantly stretched during systole and the distance to which the aorta is stretched decreases with age. The measurement of the longitudinal displacement of the aortic annulus using the CMR is feasible and reproducible.

The risk of aortic dissection should be assessed based not only on the aortic diameter, but also on other biomechanical parameters that have an impact on the stress in the aortic wall. This study evaluates very rare clinical scenarios of patients with both pre- and post-dissection computed tomography (CT) images and evaluates whether an increased wall stress correlates with the localization of an intimal entry tear in Type A aortic dissection. CT-angiography images of 4 patients performed shortly prior to and after developing Type A aortic dissection were evaluated. The stress distribution in the pre-dissection aortas was evaluated using the finite elements method. Then, the areas of high stress in the pre-dissection aortas were compared to the localization of the intimal entry tears in the dissected vessels. In all the patients, the pre-dissection areas of high wall stress correlated with the location of the intimal tears. The highest stress was not observed in the most dilated segments of the aorta but was predominantly found in the areas of an abrupt change in the geometry of the aorta. Wall stress can indicate the areas susceptible to the formation of an intimal tear and subsequent aortic dissection. Stress analysis may be a valuable tool to predict the risk of aortic dissection in patients with aortic dilatation.