ORIGINAL ARTICLES

Variation in the histopathological features of patients with ascending aortic aneurysms: a study of 111 surgically excised cases

M J Collins¹, V Dev¹, B H Strauss^3,4, P W M Fedak² and J Butany^1,4

¹ Department of Pathology, Toronto General Hospital, Toronto, Ontario, Canada
² Department of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
³ Department of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
⁴ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

Correspondence to:
Dr Jagdish Butany, Department of Pathology E11-420, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada; jagdish.butany{at}uhn.on.ca

Background: Ascending aortic aneurysms (AA) are a common, though poorly understood medical condition.

Aims: To document the histological changes in a large series of human ascending AA, and to correlate these changes with clinical variables.

Methods: 111 ascending AA were excised at surgery over a 3 year period. Each aneurysm was received as a continuous ring of tissue. Sections were taken from the anterior, posterior, greater and lesser curvature of the aorta and graded in a semi-quantitative fashion for the degree of elastin fragmentation, elastin loss, smooth muscle cell (SMC) loss, intimal changes and inflammation.

Results: Mean patient age at surgery was 58.7 (15.6) years; there were 70 men and 41 women. 12 patients had Marfan syndrome, 34 (30.6%) had a bicuspid aortic valve (BAV), while 71 (64.0%) had a tricuspid aortic valve (TAV). Inflammatory cells were present in 28 cases (25.2%) and were confined to the adventitia. No particular region of the aortic circumference was more severely affected, however a BAV was associated with significantly less intimal change, and less fragmentation and loss of elastic tissue compared with patients with a TAV. Advanced age (>65 years), female gender and Marfan syndrome were all associated with more severe elastin degeneration and smooth muscle cell loss (p<0.05 for all).

Conclusion: Results indicate a wide variation in the histological appearance in ascending AA, depending on patient characteristics. They suggest that the underlying aneurysm pathogenesis may also be highly variable; this warrants further investigation.

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