Histological regional analysis of the aortic root and thoracic ascending aorta: a complete analysis of aneurysms from root to arch

Background Although aortic root and ascending aortic aneurysms are treated the same, they differ in embryological development and pathological processes. This study examines the microscopic structural differences between aortic root and ascending aortic aneurysms, correlating these features to the macroscopic pathophysiological processes. Methods We obtained surgical samples from ascending aortic aneurysms (n = 11), aortic root aneurysms (n = 3), and non-aneurysmal patients (n = 7), Aortic collagen and elastin content were examined via histological analysis, and immunohistochemistry techniques used to determine collagen I, III, and IV subtypes. Analysis was via observational features, and colour deconvolution quantification techniques. Results Elastin fiber disruption and fragmentation was the most extensive in the proximal aneurysmal regions. Medial fibrosis and collagen density increased in proximal aneurysmal regions and aortic root aneurysms (p < 0.005). Collagen I was seen in highest quantity in aortic root aneurysms. Collagen I content was greatest in the sinus tissue regions compared to the valvular and ostial regions (p < 0.005) Collagen III and IV quantification did not vary greatly. The most susceptible regions to ultrastructural changes in disease are the proximal ascending aorta and aortic root. Conclusions The aortic root differs histologically from the ascending aorta confirming its unique composition in aneurysm pathology. These findings should prompt further evaluation on the influence of this altered structure on function which could potentially guide clinical management.

Automated summary

The study revealed that elastin fiber disruption was most severe in the proximal aneurysmal regions, with increased medial fibrosis and collagen density in the proximal aneurysmal regions and aortic root aneurysms (p < 0.005). Collagen I was found in highest quantity in aortic root aneurysms, particularly in the sinus tissue regions compared to the valvular and ostial regions (p < 0.005). The susceptibility to ultrastructural changes in disease was highest in the proximal ascending aorta and aortic root.