Only 2 comprehensive surgical series, published in 1977 and 1983, have evaluated clinicopathologic features of the ascending aorta. Retrospective review of medical records and microscopic slides was performed on 513 consecutive patients with surgical resection of ascending aortic tissue (1985 to 1999). Patients were 2 to 89 years old (mean 59 y), and 303 (59%) were men. Aneurysm or dissection was the indication for surgery in 479. Aortic valves were also excised in 360. Systemic hypertension was present in 279, inherited connective tissue disease (ICTD) in 67, arteritis in 33, and acquired connective tissue disease in 16. Microscopy showed cystic medial degeneration (CMD) in 209, aortic dissection (AD) in 109 (with CMD in 56), normal media in 90, aortitis in 57 (with CMD in 14), and other findings in 48. The most significant, independent risk factor of CMD and AD was ICTD (confidence interval=7.61 and 2.26, respectively). Systemic hypertension was more common in patients with AD than without (P=0.0202). Normal media was the most common histologic finding associated with bicuspid aortic valve (P<0.0001). Among 57 patients with aortitis (giant cell in 39), ages ranged from 16 to 85 years (mean 64 y), and 42 (74%) were women; only 8 had Takayasu arteritis, and 11 had temporal or systemic arteritis. In surgically resected ascending aorta, the 3 most common histologic findings were CMD, AD, and normal media. ICTD, systemic hypertension, and bicuspid aortic valve were common comorbid findings. Giant cell aortitis occured predominantly in women, usually without systemic disease.

译文

只有2个全面的外科系列,发表于1977年和1983,评估了升主动脉的临床病理特征。对连续513例手术切除升主动脉组织的患者 (1985例1999年) 进行了病历和显微镜切片的回顾性回顾。患者为2至89岁 (平均59岁),303 (59%) 为男性。动脉瘤或夹层是479手术的指征。主动脉瓣也在360中切除。279存在全身性高血压,遗传性结缔组织病 (ICTD) 67例,动脉炎33例,获得性结缔组织病16例。显微镜检查显示209的囊性内侧变性 (CMD),109的主动脉夹层 (AD) (CMD为56),正常介质为90,主动脉炎为57 (CMD为14),其他发现为48。CMD和AD最重要的独立危险因素是ICTD (置信区间分别为7.61和2.26)。全身性高血压在AD患者中比没有AD患者更常见 (P = 0.0202)。正常介质是与二叶主动脉瓣相关的最常见组织学发现 (P<0.0001)。在57例主动脉炎患者 (巨细胞39例) 中,年龄从16岁到85岁 (平均64岁),女性42例 (74% 例); 只有8例患有大动脉炎,11例患有颞动脉炎或全身性动脉炎。在手术切除的升主动脉中,最常见的3种组织学发现是CMD,AD和正常介质。ICTD,全身性高血压和二叶主动脉瓣是常见的合并症。巨细胞主动脉炎主要发生在女性,通常没有全身性疾病。

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