Preface

An aortic aneurysm is an enlargement of the aorta. It is a major global public health problem with unmet needs regarding primary prevention. Aortic aneurysm has an incidence of up to 10 cases per 100,000, and is more common in men older than 60 years. Aortic aneurysm leads to at least 15,000 deaths when it ruptures due to the enlarged aortic wall's weakening. Aneurysm of the aorta can start anywhere from the aortic valve sinuses to the common iliac arteries. Aortic aneurysm etiology remains unknown, yet common cardiovascular risk factors remain strongly associated. Aortic aneurysm mortality has not declined despite our innovations, education, and contributions.

This book reviews the latest information on the diagnosis and surveillance of aortic root dilation, mycotic aortic aneurysm, and the role of human immunodeficiency virus. Written by international experts, chapters discuss such topics as animal models for abdominal aortic aneurysm, safe methods of repairing type A aortic dissection, and challenges in data image analysis. Each chapter is illustrated with tables, figures, and diagrams to enhance content, and contains references for further information. The book provides a simple framework for those who want to understand the principles of aortic aneurysm and aortic dissection repair. It provides a global outlook on the disease and its diagnosis and management.

We hope this book will be of value to all clinicians and healthcare providers as well as patients who want to learn more about aortic aneurysm and aortic dissection. Cardiologists, cardiac surgeons, cardiac pathologists, and radiologists will also learn from this book how to help care for patients with this disease.

> **Jeffrey Shuhaiber MD** University of Massachusetts, USA

**1**

**Chapter 1**

**Abstract**

**1. Introduction**

Diagnosis and Surveillance of

Aortic root dilation (AoD) imparts increased risk of aortic complications such as dissection, rupture, and valvular regurgitation. Multiple etiologies of AoD exist, such as Marfan syndrome, bicuspid aortic valve, Ehler-Danlos syndrome, infections, and idiopathic conditions. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities, and pharmacologic therapies is critical. This chapter will review the various etiologies of AoD, pathophysiological basis of each disease entity, overview of the diagnosis of AoD, noninvasive imaging modalities employed for detection and surveillance, pharmacological therapies used in the prevention and management, and the factors that guide intervention such as surgical repair.

**Keywords:** aortic root, enlargement, dilation, aneurysm, noninvasive imaging

appropriate imaging modalities, and treatment strategies to manage AoD.

Multiple etiologies of AoD exist such as Marfan syndrome, bicuspid aortic valve,

Loeys-Dietz and Ehler-Danlos syndromes, idiopathic conditions, hypertension,

**2. Etiologies of aortic root dilation**

Aortic root dilation (AoD) is frequently an incidentally discovered, asymptomatic finding in that is seen on various imaging modalities [1]. The anatomy of the aortic root includes the annulus, sinuses of Valsalva, sinotubular junction and ascending aorta [1], with the size being a function of a patient's biologic variables such as height, age, BSA, and gender [1, 2]. However, while natural variations in the size of the aortic root are well known, the identification of progression from normal to pathologic AoD is a key clinical diagnosis that carries significant cardiovascular risk including aortic dissection, rupture, valvular regurgitation and cardiac tamponade [1, 3–5]. The etiology of pathological AoD is varied, ranging from congenital, infectious, autoimmune, and idiopathic conditions; and influences the medical and surgical management [1, 5]. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities and pharmacologic therapies is critical. The aim of this chapter is to review the most common conditions associated with AoD,

*Ozan Unlu, Zaid I. Almarzooq, Diala Steitieh,* 

*Matthew Brandorff and Parmanand Singh*

Aortic Root Dilation
