Dr. Patrick Bruneval
This session covered interesting fundamental and paraclinical aspects of the diseases of the aorta. The first presentation by Dr C Basso reminded the audience of the diversity of aortic diseases. The aorta is a living tissue exhibiting inflammatory and/or degenerative responses. Some pathological patterns are specific such as atherosclerosis, whereas frequently the lesions are not definite for an etiology, either in inflammatory diseases (Takayasu disease, giant cell arteritis, infectious arteritis) or in aneurysms and dissections. Indeed similar patterns associating elastic fibre loss, medial cystic degeneration, and loss of vascular smooth muscle cells are observed in thoracic aorta aneurysms/dissections either from genetic (Marfan syndrome...), malformative (bicuspid aortic valve), or ageing origins. Clinical background, cardiovascular imaging, and genetics remain crucial to classify the aorta diseases. The second presentation by Dr C Boileau masterfully gave us an overview of the genetics of aorta diseases. The genetics of thoracic aorta aneurysms/dissections is radically different from that of the abdominal aorta. Genetics clearly is a powerful tool to break up the different entities presenting as a common denominator, the thoracic aorta aneurysm/dissection phenotype with non specific pathological lesions. The genes and molecules involved in thoracic aorta aneurysm/dissection have been presented in a skilled manner. Practical take-home messages concerning the penetrance and other tricky phenomena in the genetics of these diseases were interestingly presented. The third talk by Dr Fattori emphasized the power of cardiovascular imaging in the diagnosis of aorta diseases, particularly in thoracic aorta aneurysms/dissections. The basic tool is echo, mainly TEE with a 95-100% sensitivity. High performance CT (MDCT) and MRI are even more sensitive. Pictures were presented during this talk. In fact, in terms of dissections, the problem is the emergency and the delay to have access to modern imaging and skilled radiologists. The final talk was by Dr Suzuki presenting a large panel of biomarkers useful in the diagnosis of aneurysms and dissections. Biomarkers are the products of vascular cells and the coagulation system and are released into the blood during aortic injury. Some of them are early markers with good specificity. They could contribute to dissection diagnosis but so far, they do not replace cardiovascular imaging.
The aorta: a mysterious organ
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