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Aortic and Carotid Disease PDF Print E-mail

The GCRG has been a leader in the development of both three-dimensional echocardiography and percutaneous valve repair and replacement technology. Expansion of the GCRG’s work into additional areas of cardiovascular pathophysiology, including internal carotid stenosis, thoracic aortic dissections and aneurysms, and congenital and acquired valve disease, will allow Penn Medicine an unsurpassed ability to offer state of the art care in the future.  Under the direction of Dr. Benjamin Jackson, we are currently actively involved in the following projects:

  1. Rupture Risk of Saccular Descending Thoracic Aortic Aneurysms by Stress Modeling: 1Saccular aortic aneurysms are perceived to have an increased risk of rupture compared to fusiform aneurysms. Three-dimensional meshes of the aorta were created from CTA scan data of subjects with fusiform and saccular descending thoracic aortic aneurysms. Finite element analysis (FEA) was then performed to determine wall stress (Figure 1). When normalized by diameter, the wall stress of saccular aneurysms was found to be greater than that for fusiform aneurysms, indicating that geometric factors (such as aneurysm shape) influence wall stress and rupture risk. This finding provides a rationale for the repair of saccular aneurysms at a smaller diameter, and suggests a role for biomechanical modeling in surgical decision-making
  2. Pathogenesis of Acute Aortic Dissection: 2Three-dimensional meshes of the thoracic aorta were created from ECG-gated CTA. FEA was then used to predict regional thoracic aortic wall stress. Local maxima of wall stress were identified above the sinotubular junction in the ascending aorta (Figure 2) and distal to the left subclavian artery (Figure 3). This stress distribution may contribute to the pathogenesis of aortic dissections, given the co-localization with clinically-observed entry tears. Future investigations to determine the utility of image-derived biomechanical calculations in predicting aortic dissection are warranted, and therapies designed to reduce the pressure load-induced wall stress in the thoracic aorta are rational.3

  3. Real-time three-dimensional ultrasound accurately diagnoses and stages carotid occlusive disease: Real-time three-dimensional ultrasound (rt-3DUS) has not been reported in the evaluation of carotid artery occlusive disease.  Duplex imaging and rt-3DUS were performed in patients with suspected carotid occlusive disease, and compared to data from standard 2D duplex imaging. Percent linear and percent areal stenosis, and peak systolic velocity, correlated highly with 2D duplex. The results indicate that rt-3DUS can accurately diagnose and stage carotid occlusive disease.  This technique provides a new approach to obtaining 3D carotid anatomic imaging without radiation exposure or iodinated contrast administration.
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Perelman School of Medicine at the University of Pennsylvania.