{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:04:53Z","timestamp":1791821093956,"version":"4.3.4"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2002<\/jats:title>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The goal of therapy of proximal aortic aneurysms is to prevent an aortic catastrophe, e.g. acute dissection or rupture. The decision to intervene is currently based on maximum aortic diameter complemented by known risk factors like bicuspid aortic valve, positive family history or rapid growth rate. When applying Laplace\u2019s law, wall tension is determined by pressure \u00d7 radius divided by aortic wall thickness. Because current imaging modalities lack precision, wall thickness is currently neglected. The purpose of our study was therefore to correlate maximum aortic diameter with aortic wall thickness and known indices for adverse aortic events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Aortic samples from 292 patients were collected during cardiac surgery, of whom 158 presented with a bicuspid aortic valve and 134, with a tricuspid aortic valve. Aortic specimens were obtained during the operation and stored in 4% formaldehyde. Histological staining and analysis were performed to determine the thickness of the aortic wall.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Patients were 62\u2009\u00b1\u200913\u2009years old at the time of the operation; 77% were men. The mean aortic dimensions were 44\u2009mm, 41\u2009mm and 51\u2009mm at the aortic root, sinotubular junction and ascending aorta, respectively. Aortic valve stenosis was the most frequent (49%) valvular dysfunction, followed by aortic valve regurgitation (33%) and combined dysfunction (10%). The maximum aortic diameter at the ascending level did not correlate with the thickness of the media (R\u2009=\u20090.07) or the intima (R\u2009=\u20090.28) at the convex sample site. There was also no correlation of the ascending aortic diameter with age (R = \u22120.18) or body surface area (R\u2009=\u20090.07). The thickness of the intima (r\u2009=\u20090.31) and the media (R\u2009=\u20090.035) did not correlate with the Svensson index of aortic risk. Similarly, there was a low (R\u2009=\u20090.29) or absent (R = \u22120.04) correlation between the aortic size index and the intima or media thickness, respectively. There was a similar relationship of median thickness of the intima in the 4 aortic height index risk categories (P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Aortic diameter and conventional indices of aortic risk do not correlate with aortic wall thickness. Other indices may be required in order to identify patients at high risk for aortic complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab147","type":"journal-article","created":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T20:11:39Z","timestamp":1615234299000},"page":"322-330","source":"Crossref","is-referenced-by-count":11,"title":["Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness"],"prefix":"10.1093","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-5841","authenticated-orcid":false,"given":"Josephina","family":"Haunschild","sequence":"first","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7053-9015","authenticated-orcid":false,"given":"Sarah Jane","family":"Barnard","sequence":"additional","affiliation":[{"name":"Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Misfeld","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia"},{"name":"The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7449-9455","authenticated-orcid":false,"given":"Diyar","family":"Saeed","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1967-8949","authenticated-orcid":false,"given":"Piroze","family":"Davierwala","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Leontyev","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8107-4797","authenticated-orcid":false,"given":"Meinhard","family":"Mende","sequence":"additional","affiliation":[{"name":"Centre for Clinical Trials, University of Leipzig, Leipzig, Germany"},{"name":"Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Borger","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8224-2390","authenticated-orcid":false,"given":"Christian D","family":"Etz","sequence":"additional","affiliation":[{"name":"University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"},{"name":"Saxonian Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,5]]},"reference":[{"key":"2021080208043976400_ezab147-B1","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.jtcvs.2018.02.115","article-title":"The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: full online-only version","volume":"156","author":"Borger","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B2","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"2021080208043976400_ezab147-B3","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1016\/j.jtcvs.2012.11.067","article-title":"Indications for aortic aneurysmectomy: too many variables and not enough equations?","volume":"145","author":"Sundt","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B4","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1136\/heartjnl-2013-304606","article-title":"Type A aortic dissection in patients with bicuspid aortic valves: clinical and pathological comparison with tricuspid aortic valves","volume":"99","author":"Eleid","year":"2013","journal-title":"Heart"},{"key":"2021080208043976400_ezab147-B5","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.ejcts.2008.12.047","article-title":"Aortic size in acute type A dissection: implications for preventive ascending aortic replacement","volume":"35","author":"Parish","year":"2009","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021080208043976400_ezab147-B6","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/S0022-5223(03)00608-1","article-title":"Relationship of aortic cross-sectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves","volume":"126","author":"Svensson","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B7","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.athoracsur.2005.06.026","article-title":"Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms","volume":"81","author":"Davies","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2021080208043976400_ezab147-B8","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.jtcvs.2017.10.140","article-title":"Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm","volume":"155","author":"Zafar","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B9","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.jtcvs.2007.01.039","article-title":"A classification system for the bicuspid aortic valve from 304 surgical specimens","volume":"133","author":"Sievers","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B10","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1093\/ejcts\/ezs341","article-title":"Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases","volume":"43","author":"Deschka","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021080208043976400_ezab147-B11","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.athoracsur.2016.07.018","article-title":"Granular media calcinosis in the aortic walls of patients with bicuspid and tricuspid aortic valves","volume":"103","author":"Haunschild","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2021080208043976400_ezab147-B12","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.aanat.2010.02.006","article-title":"Inhibition of caspase-3 differentially affects vascular smooth muscle cell apoptosis in the concave versus convex aortic sites in ascending aneurysms with a bicuspid aortic valve","volume":"192","author":"Mohamed","year":"2010","journal-title":"Ann Anat"},{"key":"2021080208043976400_ezab147-B13","volume-title":"IBM SPSS Statistics for Windows, Version 26.0","year":"2019"},{"key":"2021080208043976400_ezab147-B14","volume-title":"R: A Language and Environment for Statistical Computing","year":"2020"},{"key":"2021080208043976400_ezab147-B15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/1467-985X.00122","article-title":"Building multivariable prognostic and diagnostic models: transformation of the predictors by using fractional polynomials","volume":"162","author":"Sauerbrei","year":"1999","journal-title":"J R Stat Soc"},{"key":"2021080208043976400_ezab147-B16","first-page":"17","article-title":"Aortic wall thickness: an independent risk factor for aortic dissection?","volume":"23","author":"Shiran","year":"2014","journal-title":"J Heart Valve Dis"},{"key":"2021080208043976400_ezab147-B17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.carpath.2019.03.002","article-title":"The role of hemodynamics in bicuspid aortopathy: a histopathologic study","volume":"41","author":"Grewal","year":"2019","journal-title":"Cardiovasc Pathol"},{"key":"2021080208043976400_ezab147-B18","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1093\/ejcts\/ezv197","article-title":"Aortic wall thickness in patients with ascending aortic aneurysm versus acute aortic dissection","volume":"49","author":"Van Puyvelde","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021080208043976400_ezab147-B19","doi-asserted-by":"crossref","first-page":"379","DOI":"10.3400\/avd.oa.19-00051","article-title":"Changes in aortic wall thickness at a site of entry tear on computed tomography before development of acute aortic dissection","volume":"12","author":"Saito","year":"2019","journal-title":"Ann Vasc Dis"},{"key":"2021080208043976400_ezab147-B20","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1093\/icvts\/ivy158","article-title":"Wall stress correlates with intimal entry tear localization in Type A aortic dissection","volume":"27","author":"Plonek","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2021080208043976400_ezab147-B21","doi-asserted-by":"crossref","first-page":"e005959","DOI":"10.1161\/JAHA.117.005959","article-title":"Aortic valve stenosis alters expression of regional aortic wall shear stress: new insights from a 4-dimensional flow magnetic resonance imaging study of 571 subjects","volume":"6","author":"van Ooij","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2021080208043976400_ezab147-B22","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.jtcvs.2016.12.059","article-title":"Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency","volume":"153","author":"Shan","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B23","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1093\/ejcts\/ezt123","article-title":"Is there any difference in aortic wall quality between patients with aortic stenosis and those with regurgitation?","volume":"44","author":"Benedik","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021080208043976400_ezab147-B24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000342436","article-title":"Possible mechanical roles of glycosaminoglycans in thoracic aortic dissection and associations with dysregulated transforming growth factor-beta","volume":"50","author":"Humphrey","year":"2013","journal-title":"J Vasc Res"},{"key":"2021080208043976400_ezab147-B25","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jbiomech.2018.01.037","article-title":"Structural modeling reveals microstructure-strength relationship for human ascending thoracic aorta","volume":"71","author":"Thunes","year":"2018","journal-title":"J Biomech"},{"key":"2021080208043976400_ezab147-B26","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.jtcvs.2013.04.028","article-title":"Mechanism of aortic medial matrix remodeling is distinct in patients with bicuspid aortic valve","volume":"147","author":"Phillippi","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021080208043976400_ezab147-B27","doi-asserted-by":"crossref","first-page":"e000034","DOI":"10.1161\/JAHA.112.000034","article-title":"Impaired collagen biosynthesis and cross-linking in aorta of patients with bicuspid aortic valve","volume":"2","author":"Wagsater","year":"2013","journal-title":"J Am Heart Assoc"},{"key":"2021080208043976400_ezab147-B28","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1016\/j.athoracsur.2010.06.115","article-title":"When to operate on the bicuspid valve patient with a modestly dilated ascending aorta","volume":"90","author":"Etz","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2021080208043976400_ezab147-B29","doi-asserted-by":"crossref","first-page":"4782","DOI":"10.3390\/ijms20194782","article-title":"Strong signs for a weak wall in tricuspid aortic valve associated aneurysms and a role for osteopontin in bicuspid aortic valve associated aneurysms","volume":"20","author":"Stern","year":"2019","journal-title":"Int J Mol Sci"},{"key":"2021080208043976400_ezab147-B30","first-page":"74","article-title":"Intima-media thickness of the descending aorta in patients with bicuspid aortic valve","volume":"11","author":"Petrini","year":"2016","journal-title":"Int J Cardiol Heart Vasc"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/2\/322\/39502673\/ezab147.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/2\/322\/39502673\/ezab147.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T08:15:56Z","timestamp":1627892156000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/60\/2\/322\/6210648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,5]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,4,5]]},"published-print":{"date-parts":[[2021,7,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezab147","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,8,1]]},"published":{"date-parts":[[2021,4,5]]}}}