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AORTIC ANEURYSM

AORTIC ANEURYSM. AORTIC ANEURYSM. CARDIOVASCULAR SYSTEM. Pathogenesis: Defect of vessel wall connective tissue Marfan’s syndrome (fibrillin) Loeys-Dietz syndrome (elastin, collagen I, II) Ehlers-Danlos syndrome (collagen III) Vitamin C deficiency (collagen cross linking).

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AORTIC ANEURYSM

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  1. AORTIC ANEURYSM

  2. AORTIC ANEURYSM

  3. CARDIOVASCULAR SYSTEM Pathogenesis: • Defect of vessel wall connective tissue Marfan’s syndrome (fibrillin) Loeys-Dietz syndrome (elastin, collagen I, II) Ehlers-Danlos syndrome (collagen III) Vitamin C deficiency (collagen cross linking)

  4. CARDIOVASCULAR SYSTEM • Disturbed balance of collagen synthesis & degradation inflammatory infiltrates ↑ MMP (macrophages in AS, vasculitis) ↓ TIMP

  5. CARDIOVASCULAR SYSTEM • Loss of smooth muscle cells or defective ECM Ischemia of inner media AS thickening of intima HTN  narrow vasa vasorum degenerative changes  smooth muscle cell loss  scarring  inadequate ECM ↑ amorphous ground substance “Cystic Medial Degeneration”

  6. CARDIOVASCULAR SYSTEM Atherosclerosis (Abdominal aorta) Aneurysm Hypertension (ascending aorta)

  7. CARDIOVASCULAR SYSTEM Other causes: Trauma (A-V aneurysms) Congenital defects (berry aneurysms) Infections (mycotic) embolization (infective endocarditis) adjacent suppurative lesion bacteremia Vasculitis

  8. CARDIOVASCULAR SYSTEM Types: Saccular Fusiform Sites: Abdominal aorta Common iliac artery Arch of aorta Descending thoracic aorta

  9. CARDIOVASCULAR SYSTEM ABDOMINAL AORTIC ANEURYSMS(AAA): Atherosclerosis > 50 yrs > males, smokers genetic susceptibility  ↓ connective tissue strength MMP  TIMP HTN

  10. CARDIOVASCULAR SYSTEM Morphology: B/W bifurcation & renal arteries saccular/fusiform variable size thromboemboli occlusion of ostia

  11. CARDIOVASCULAR SYSTEM Variants: Inflammatory AAA dense periaortic fibrosis inflammatory cells (lymphos, plasma cells, macrophages, giant cells) Mycotic AAA AS AAA + bacteremia Salmonella gastroentritis

  12. CARDIOVASCULAR SYSTEM Complications: Rupture Obstruction adjacent BV Embolism Compression adjacent structures Abdominal mass

  13. CARDIOVASCULAR SYSTEM SYPHILITIC ANEURYSM: Leutic Obliterative endartritis vasa vasorum lymphocytes & plasma cells syphilitic aortitis

  14. CARDIOVASCULAR SYSTEM weakening of media tree barking aortic valve insufficiency cor bovinum (cow’s heart)

  15. SYPHILITIC ANEURYSM

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