Ascending aorta dissection in a new classification system: Clinicopathological features of 62 cases

• Published in: Pathology, research and practice Vol. 224; p. 153542
• Main Authors: Stejskal, Václav, Karalko, Mikita, Šteiner, Ivo
• Format: Journal Article
• Language: English
• Published: Germany Elsevier GmbH 01-08-2021
• Subjects: Aged; Aneurysm, Dissecting - pathology; Aorta - pathology; Aortic Diseases - pathology; Aortic Valve - pathology; Ascending aorta; Atherosclerosis; Atherosclerosis - pathology; Bicuspid aortic valve; Dissection; Female; Humans; Male; Medial degeneration; Middle Aged; Myocytes, Smooth Muscle - pathology; Ascending aorta; Medial degeneration; Dissection; Atherosclerosis; Bicuspid aortic valve
• ISSN: 0344-0338; 1618-0631
• DOI: 10.1016/j.prp.2021.153542

Herein we present a single institution 5-year experience with ascending aorta dissection biopsies depicting the clinicopathological features of 62 cases. To detect microscopic abnormalities in the aortic wall beside the dissection itself, we applied a new histopathological classification scheme from the consensus documents issued by The Society for Cardiovascular Pathology and The Association for the European Cardiovascular Pathology in 2015 and 2016. The most common finding was medial degeneration (MD) - 61 cases (98.4%); atherosclerosis (AS) was found in 19 aortae (30.6%), and chronic aortitis- giant cell pattern described in one aorta (1.6%). The medial degeneration constituents included mucoid matrix accumulation, smooth muscle cells and elastic fibers abnormalities, and medial fibrosis. The consensus document application led to increased MD reporting compared to older studies and to our previous experience, probably due to assessing more subtle and focal changes such as intralamellar fibrosis, intralamellar mucoid matrix accumulation, and loss of smooth muscle cell nuclei- these changes being also the most common MD abnormalities we are reporting. We have compared the results in patients with bicuspid (n = 7; 11.3%) versus tricuspid (n = 55; 88.7%) aortic valve, suggesting no significant differences except for translamellar fibrosis, which appeared to be more severe in the bicuspid valve group (p = 0.0397). The results might imply similar histopathological findings regardless of the aortic valve cuspidity in aortic dissection. These findings are in contrast to ascending aorta dilation (aneurysm), where more severe medial degeneration changes have been described in patients with the tricuspid aortic valve.