Insights From the Histopathologic Analysis of Acquired and Genetic Thoracic Aortic Aneurysms and Dissections

• Published in: Texas Heart Institute journal Vol. 51; no. 1; pp. 1 - 13
• Main Authors: Buja, L Maximilian, Zhao, Bihong, Sadaf, Humaira, McDonald, Michelle, Segura, Ana M, Li, Li, Cecchi, Alana, Prakash, Siddharth K, Afifi, Rana O, Miller, Charles C, Estrera, Anthony L, Milewicz, Dianna M
• Format: Journal Article
• Language: English
• Published: United States Texas Heart® Institute, Houston 12-02-2024; The Texas Heart Institute
• Subjects: aortic aneurysm; aortic dissection; Clinical Investigation; pathology; tunica media; pathology; Aortic aneurysm; aortic dissection; tunica media
• ISSN: 0730-2347; 1526-6702
• DOI: 10.14503/THIJ-23-8253

The purpose of this study was to apply contemporary consensus criteria developed by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology to the evaluation of aortic pathology, with the expectation that the additional pathologic information may enhance the understanding and management of aortic diseases.
A scoring system was applied to ascending aortic specimens from 42 patients with heritable thoracic aortic disease and known genetic variations and from 86 patients from a single year, including patients with known genetic variations (n = 12) and patients with sporadic disease (n = 74).
The various types of lesions of medial degeneration and the overall severity of medial degeneration overlapped considerably between those patients with heritable disease and those with sporadic disease; however, patients with heritable thoracic aortic disease had significantly more overall medial degeneration (P = .004) and higher levels of elastic fiber fragmentation (P = .03) and mucoid extracellular matrix accumulation (P = .04) than patients with sporadic thoracic aortic disease. Heritable thoracic aortic disease with known genetic variation was more prevalent in women than in men (27.2% vs 9.8%; P = .04), and women had more severe medial degeneration than men (P = .04). Medial degeneration scores were significantly lower for patients with bicuspid aortic valves than for patients with tricuspid aortic valves (P = .03).
The study's findings indicate considerable overlap in the pattern, extent, and severity of medial degeneration between sporadic and hereditary types of thoracic aortic disease. This finding suggests that histopathologic medial degeneration represents the final common outcome of diverse pathogenetic factors and mechanisms.