Changes in planimetric characteristics of the thoracic aorta after ascending aorta replacement for aneurysm in Marfan syndrome

Abstract

Objective. To investigate the planimetric characteristics of the thoracic aorta before and after replacement of the ascending aorta (AA) for aneurysm in patients with Marfan syndrome.

Material and methods. The study included 34 patients with Marfan syndrome and AA aneurysm who underwent AA replacement in our clinic between January 2010 and December 2023. Using X-ray computed tomography angiography was used to assess diameters, cross-sectional area, perimeters, asymmetry, and curvature of thoracic aortic segments.

Results. The greatest asymmetry was observed in the aortic root and the proximal and distal thirds of the aortic arch. AA curvature was most pronounced at the sinotubular junction and the tubular part of the AA. Postoperatively, an increase in thoracic aortic dimensions was noted, most significantly in cross-sectional area and perimeter. Key predictors for mid-term dilation of the aortic arch and descending thoracic aorta were identified as increased preoperative AA curvature (particularly at the sinotubular junction and tubular portion) and preoperative AA cross-sectional asymmetry (at the sinotubular junction and distal third of the AA).

Conclusion. Assessing the planimetric characteristics of the thoracic aorta before and after AA replacement in Marfan syndrome patients provides a more objective and detailed understanding of aneurysmal transformation and identifies potential predictors of disease progression in segments not addressed surgically. The significant postoperative increase in cross-sectional area and perimeter suggests that baseline geometric deformation (curvature and asymmetry) of the AA reflects more pronounced and uneven structural abnormalities of the aortic wall. This may serve as a marker for an increased risk of dilation in the remaining thoracic aortic segments even after successful AA replacement. Supplementary planimetric parameters not only offer a more comprehensive view of the aneurysmal process but also enable risk stratification for postoperative progression, helping to identify patients requiring closer monitoring.