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Heinz Jakob - One of the best experts on this subject based on the ideXlab platform.
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Role of regional Aortic Wall properties in the pathogenesis of thoracic Aortic dissection.
Scandinavian cardiovascular journal : SCJ, 2016Co-Authors: Lisa Himpel, Kevin Pilarczyk, Konstantinos Tsagakis, Heinz Jakob, Aziz Wahbi, Fanar Mourad, Jaroslav BenedikAbstract:AbstractObjectives. The mechanisms of the location and extension of acute Aortic dissection (AD) are only poorly understood. The aim of this study was to compare the cohesion of the non-coronary Aortic sinus (NAS) and the ascending Aortic Wall (AA) using the Dissectometer – a new device for analyses of the mechanical properties of the aorta. Design. The properties of the Aortic Wall were analyzed with the “Dissectometer” (parameters P7, P8 and P9) in adult patients undergoing Aortic root (AR) replacement in two different segments: NAS and AA. The Aortic Wall thickness (AWT) was measured with a micrometer. Results. Thirty-three adult patients (mean age 65 ± 14 years, 80% male) were included in this study. The Aortic Wall of the NAS was significantly thinner than that of the AA (1.9 ± 0.4 vs. 2.3 ± 0.4, p
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Detection of Aortic Wall instability with the new dissectometer: Correlation with histological findings.
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, 2015Co-Authors: Kevin Pilarczyk, Konstantinos Tsagakis, Heinz Jakob, Matthias Thielmann, Mareike Perrey, Hideo A. Baba, Vivien Price, Jaroslav BenedikAbstract:AbstractObjectives: Although risk stratification for Aortic dissection or rupture based on Aortic diameter is quite suboptimal, alternative methods for the assessment of the Aortic Wall stability are rare. We assessed the mechanical properties of the Aortic Wall by a new custom-made device mimicking transversal Aortic Wall shear stress during open heart surgery in comparison with histological examination. Material and methods: One-hundred and five Aortic Walls were tested by the ‘dissectometer’ (seven different measured and two calculated values) as well as histological examination was performed. Results: Histological examination classified the Aortic Wall as normal in 54 (51.4%) patients and pathologic in 51 (48.6%) patients. Six out of nine parameters assessed by the dissectometer showed a significant correlation to histological findings. Using ROC-analysis, the most reliable parameter (P9) showed a sensitivity of 93.3% and a specificity of 80.4% with an area under the curve of 0.89 when using a cut-off...
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is there any difference in Aortic Wall quality between patients with Aortic stenosis and those with regurgitation
European Journal of Cardio-Thoracic Surgery, 2013Co-Authors: Jaroslav Benedik, Daniel Wendt, Konstantinos Tsagakis, Mareike Perrey, Hideo A. Baba, Vivien Price, Kevin Pilarzcyk, Heinz JakobAbstract:OBJECTIVES: The interaction between Aortic valve (AV) and Aortic Wall pathology is currently unclear. No intraoperative examination or investigation is able to predict postoperative dissection or aneurysm formation in patients operated on for primary AV pathology. The aim of the present study was therefore to evaluate the mechanical and histological properties of the Aortic Wall in patients operated on for Aortic stenosis (AS) or regurgitation (AR). METHODS: The Aortic Walls of 229 patients (age 67.5 ± 11.0 years) operated on for AS (n= 135, Group 1) or AR (n= 94, Group 2) were subjected to mechanical stress testing and postoperative histological examination. Ascending Aortic diameter was ≥50 mm in 46/229 patients and 40–49 mm in 52/229 patients. RESULTS: AR was associated with an increased tendency to Aortic media disruption (P< 0.001) and with media degeneration (P< 0.001) compared with AS patients. The incidence of Aortic aneurysm (≥50 mm) was increased in AR patients (35 in AR and 11 in AS, P< 0.01). The Aortic Wall cohesion was better in patients with an Aortic diameter of <40 mm compared with those with moderate dilatation of 40–49 mm (P= 0.009) or an Aortic aneurysm (P= 0.002). CONCLUSIONS: Our study proves that patients presenting for AV replacement with AR have a poorer quality of the ascending aorta despite a superior thickness compared with patients with AS. In addition, patients with a slightly dilated aorta (40–49 mm) have a poorer cohesion of the Aortic Wall than those with normal Aortic dimensions.
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Is there any difference in Aortic Wall quality between patients with Aortic stenosis and those with regurgitation
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2013Co-Authors: Jaroslav Benedik, Daniel Wendt, Konstantinos Tsagakis, Mareike Perrey, Hideo A. Baba, Vivien Price, Kevin Pilarzcyk, Heinz JakobAbstract:OBJECTIVES: The interaction between Aortic valve (AV) and Aortic Wall pathology is currently unclear. No intraoperative examination or investigation is able to predict postoperative dissection or aneurysm formation in patients operated on for primary AV pathology. The aim of the present study was therefore to evaluate the mechanical and histological properties of the Aortic Wall in patients operated on for Aortic stenosis (AS) or regurgitation (AR). METHODS: The Aortic Walls of 229 patients (age 67.5 ± 11.0 years) operated on for AS (n= 135, Group 1) or AR (n= 94, Group 2) were subjected to mechanical stress testing and postoperative histological examination. Ascending Aortic diameter was ≥50 mm in 46/229 patients and 40–49 mm in 52/229 patients. RESULTS: AR was associated with an increased tendency to Aortic media disruption (P< 0.001) and with media degeneration (P< 0.001) compared with AS patients. The incidence of Aortic aneurysm (≥50 mm) was increased in AR patients (35 in AR and 11 in AS, P< 0.01). The Aortic Wall cohesion was better in patients with an Aortic diameter of
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Ascending Aortic Wall Cohesion: Comparison of Bicuspid and Tricuspid Valves
Cardiology research and practice, 2012Co-Authors: Jaroslav Benedik, Kevin Pilarczyk, Daniel Wendt, Jiri Indruch, Radek Flek, Konstantinos Tsagakis, Savvas Alaeddine, Heinz JakobAbstract:Objectives. Bicuspid Aortic valve (AV) represents the most common form of congenital AV malformation, which is frequently associated with pathologies of the ascending aorta. We compared the mechanical properties of the Aortic Wall between patients with bicuspid and tricuspid AV using a new custom-made device mimicking transversal Aortic Wall shear stress. Methods. Between 03/2010 and 07/2011, 190 consecutive patients undergoing open Aortic valve replacement at our institution were prospectively enrolled, presenting either with a bicuspid (group 1,
Michael T. Janusz - One of the best experts on this subject based on the ideXlab platform.
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Aortic Wall Stress in Hypertension and Ascending Thoracic Aortic Aneurysms: Implications for Antihypertensive Therapy
High Blood Pressure & Cardiovascular Prevention, 2013Co-Authors: Simon W. Rabkin, Michael T. JanuszAbstract:The objective of this study was the evaluation of Aortic Wall stress in patients with ascending thoracic Aortic aneurysms (TAA) because of the paucity of data to guide medical therapy for blood pressure (BP) management in TAA. Twelve men, age 67.4 ± 3.3 years (SEM) with hypertension and ascending TAA without other etiology, previous Aortic surgery or associated significant Aortic valve disease, had maximum dimensions of the ascending aorta measured from CT angiogram (CTa) and transthoracic echocardiogram (TTE) with Aortic Wall thickness measured on TTE. Wall stress (WS(σ)(P)) at peak systolic BP (SBP) was expressed by the equation: WS(σ)(P) = 2LCSA × SBP/MCSA, where LCSA is ascending aorta luminal cross-sectional area; MCSA is the surface area of the Aortic Wall cross sectional area considering Aortic Wall thickness. There was no significant difference in Wall stress from TTE or CTa although mean Wall stress was slightly larger when calculated from CTa. For each 5 mmHg increment in Systolic BP (SBP), there was a 3.9 kPa increase in Wall stress that was 3.5 kPa for small aneurysms (40 to
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Aortic Wall stress in hypertension and ascending thoracic Aortic aneurysms implications for antihypertensive therapy
Annual Review of Physiology, 2013Co-Authors: Simon W. Rabkin, Michael T. JanuszAbstract:The objective of this study was the evaluation of Aortic Wall stress in patients with ascending thoracic Aortic aneurysms (TAA) because of the paucity of data to guide medical therapy for blood pressure (BP) management in TAA. Twelve men, age 67.4 ± 3.3 years (SEM) with hypertension and ascending TAA without other etiology, previous Aortic surgery or associated significant Aortic valve disease, had maximum dimensions of the ascending aorta measured from CT angiogram (CTa) and transthoracic echocardiogram (TTE) with Aortic Wall thickness measured on TTE. Wall stress (WS(σ)(P)) at peak systolic BP (SBP) was expressed by the equation: WS(σ)(P) = 2LCSA × SBP/MCSA, where LCSA is ascending aorta luminal cross-sectional area; MCSA is the surface area of the Aortic Wall cross sectional area considering Aortic Wall thickness. There was no significant difference in Wall stress from TTE or CTa although mean Wall stress was slightly larger when calculated from CTa. For each 5 mmHg increment in Systolic BP (SBP), there was a 3.9 kPa increase in Wall stress that was 3.5 kPa for small aneurysms (40 to <45 mm) and 4.4 kPa for larger aneurysms (45–52 mm). There was a 33.0 ± 1.2 % reduction in Wall stress when SBP went from 165 to 110 mmHg with a 21.0 ± 0.7 % reduction in Wall stress found when SBP was reduced from 140 to 110 mmHg. These data, in patients with hypertension and ascending TAA suggest that meaningful reductions in Aortic Wall stress occur with reductions of SBP and this benefit extends to SBP levels <140 mmHg.
Christopher K. Zarins - One of the best experts on this subject based on the ideXlab platform.
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increased anterior abdominal Aortic Wall motion possible role in aneurysm pathogenesis and design of endovascular devices
Journal of Endovascular Therapy, 2007Co-Authors: Craig J Goergen, Bonnie L Johnson, Joan M Greve, Charles A Taylor, Christopher K. ZarinsAbstract:Purpose:To determine whether variations in Aortic Wall motion exist in mammalian species other than humans and to consider the potential implications of such variations.Methods:M-mode ultrasound was used to measure abdominal Aortic Wall motion in 4 animal species [mice (n=10), rats (n=8), rabbits (n=7), and pigs (n=5)], and humans (n=6). Anterior Wall displacement, posterior Wall displacement, and diastolic diameter were measured. The ratio of displacement to diameter and cyclic strain were calculated.Results:Body mass varied from 24.1±2.4 g (mouse) to 61.8±13.4 kg (human); Aortic diameter varied from 0.53±0.07 mm (mouse) to 1.2±1 mm (human). Anterior Wall displacement was 2.5 to 4.0 times greater than posterior among the species studied. The ratios of Wall displacement to diastolic diameter were similar for the anterior (range 9.40%–11.80%) and posterior (range 2.49%–3.91%) Walls among species. The ratio of anterior to posterior displacement (range 2.47–4.03) and Aortic Wall circumferential cyclic strain...
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reduction of Aortic Wall motion inhibits hypertension mediated experimental atherosclerosis
Arteriosclerosis Thrombosis and Vascular Biology, 2000Co-Authors: Bradford I. Tropea, Phil Huie, Richard K. Sibley, Severin P Schwarzacher, Albert Y Chang, Chris Asvar, Christopher K. ZarinsAbstract:Abstract —Hypertension is a well-known risk factor for coronary artery disease and carotid and lower extremity occlusive disease. Surgically induced hypertension in hypercholesterolemic animals results in increased Aortic Wall motion and increased plaque formation. We tested the hypothesis that reduction in Aortic Wall motion, despite continued hypertension, could reduce plaque formation. New Zealand White rabbits (n=26) underwent thoracic Aortic banding to induce hypertension and were fed an atherogenic diet for 3 weeks. In 13 rabbits, a segment of aorta proximal to an Aortic band was externally wrapped to reduce Wall motion. All animals were fed an atherogenic diet for 3 weeks. Four groups were studied: 1, coarctation control (no wrap, n=7); 2, coarctation with loose wrap (n=6); 3, coarctation with firm wrap (n=7); and 4, control (noncoarcted, n=6). Wall motion, blood pressure, and pulse pressure were measured at standard reference sites proximal and distal to the coarctation by use of intravascular ultrasound. Quantitative morphometry was used to measure intimal plaque. Mean arterial pressure and cyclic Aortic Wall motion were equally increased proximal to the Aortic coarctation in all 3 coarcted rabbit groups compared with the control group ( P <0.001). Wall motion in the segment of aorta under the loose and firm wraps was no different from the control value. The external wrap significantly reduced intimal thickening in the 4 groups by the following amounts: group 1, 0.30±0.03 mm2; group 2, 0.06±0.02 mm2; group 3, 0.04±0.02 mm2; and group 4, 0.01±0.01 mm2 ( P <0.001). Localized inhibition of Aortic Wall motion in the lesion-prone hypertensive aorta resulted in significant reduction in intimal plaque formation. These data suggest that arterial Wall cyclic motion may stimulate cellular proliferation and lipid uptake in experimental atherosclerosis.
Jaroslav Benedik - One of the best experts on this subject based on the ideXlab platform.
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Role of regional Aortic Wall properties in the pathogenesis of thoracic Aortic dissection.
Scandinavian cardiovascular journal : SCJ, 2016Co-Authors: Lisa Himpel, Kevin Pilarczyk, Konstantinos Tsagakis, Heinz Jakob, Aziz Wahbi, Fanar Mourad, Jaroslav BenedikAbstract:AbstractObjectives. The mechanisms of the location and extension of acute Aortic dissection (AD) are only poorly understood. The aim of this study was to compare the cohesion of the non-coronary Aortic sinus (NAS) and the ascending Aortic Wall (AA) using the Dissectometer – a new device for analyses of the mechanical properties of the aorta. Design. The properties of the Aortic Wall were analyzed with the “Dissectometer” (parameters P7, P8 and P9) in adult patients undergoing Aortic root (AR) replacement in two different segments: NAS and AA. The Aortic Wall thickness (AWT) was measured with a micrometer. Results. Thirty-three adult patients (mean age 65 ± 14 years, 80% male) were included in this study. The Aortic Wall of the NAS was significantly thinner than that of the AA (1.9 ± 0.4 vs. 2.3 ± 0.4, p
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Detection of Aortic Wall instability with the new dissectometer: Correlation with histological findings.
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, 2015Co-Authors: Kevin Pilarczyk, Konstantinos Tsagakis, Heinz Jakob, Matthias Thielmann, Mareike Perrey, Hideo A. Baba, Vivien Price, Jaroslav BenedikAbstract:AbstractObjectives: Although risk stratification for Aortic dissection or rupture based on Aortic diameter is quite suboptimal, alternative methods for the assessment of the Aortic Wall stability are rare. We assessed the mechanical properties of the Aortic Wall by a new custom-made device mimicking transversal Aortic Wall shear stress during open heart surgery in comparison with histological examination. Material and methods: One-hundred and five Aortic Walls were tested by the ‘dissectometer’ (seven different measured and two calculated values) as well as histological examination was performed. Results: Histological examination classified the Aortic Wall as normal in 54 (51.4%) patients and pathologic in 51 (48.6%) patients. Six out of nine parameters assessed by the dissectometer showed a significant correlation to histological findings. Using ROC-analysis, the most reliable parameter (P9) showed a sensitivity of 93.3% and a specificity of 80.4% with an area under the curve of 0.89 when using a cut-off...
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is there any difference in Aortic Wall quality between patients with Aortic stenosis and those with regurgitation
European Journal of Cardio-Thoracic Surgery, 2013Co-Authors: Jaroslav Benedik, Daniel Wendt, Konstantinos Tsagakis, Mareike Perrey, Hideo A. Baba, Vivien Price, Kevin Pilarzcyk, Heinz JakobAbstract:OBJECTIVES: The interaction between Aortic valve (AV) and Aortic Wall pathology is currently unclear. No intraoperative examination or investigation is able to predict postoperative dissection or aneurysm formation in patients operated on for primary AV pathology. The aim of the present study was therefore to evaluate the mechanical and histological properties of the Aortic Wall in patients operated on for Aortic stenosis (AS) or regurgitation (AR). METHODS: The Aortic Walls of 229 patients (age 67.5 ± 11.0 years) operated on for AS (n= 135, Group 1) or AR (n= 94, Group 2) were subjected to mechanical stress testing and postoperative histological examination. Ascending Aortic diameter was ≥50 mm in 46/229 patients and 40–49 mm in 52/229 patients. RESULTS: AR was associated with an increased tendency to Aortic media disruption (P< 0.001) and with media degeneration (P< 0.001) compared with AS patients. The incidence of Aortic aneurysm (≥50 mm) was increased in AR patients (35 in AR and 11 in AS, P< 0.01). The Aortic Wall cohesion was better in patients with an Aortic diameter of <40 mm compared with those with moderate dilatation of 40–49 mm (P= 0.009) or an Aortic aneurysm (P= 0.002). CONCLUSIONS: Our study proves that patients presenting for AV replacement with AR have a poorer quality of the ascending aorta despite a superior thickness compared with patients with AS. In addition, patients with a slightly dilated aorta (40–49 mm) have a poorer cohesion of the Aortic Wall than those with normal Aortic dimensions.
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Is there any difference in Aortic Wall quality between patients with Aortic stenosis and those with regurgitation
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2013Co-Authors: Jaroslav Benedik, Daniel Wendt, Konstantinos Tsagakis, Mareike Perrey, Hideo A. Baba, Vivien Price, Kevin Pilarzcyk, Heinz JakobAbstract:OBJECTIVES: The interaction between Aortic valve (AV) and Aortic Wall pathology is currently unclear. No intraoperative examination or investigation is able to predict postoperative dissection or aneurysm formation in patients operated on for primary AV pathology. The aim of the present study was therefore to evaluate the mechanical and histological properties of the Aortic Wall in patients operated on for Aortic stenosis (AS) or regurgitation (AR). METHODS: The Aortic Walls of 229 patients (age 67.5 ± 11.0 years) operated on for AS (n= 135, Group 1) or AR (n= 94, Group 2) were subjected to mechanical stress testing and postoperative histological examination. Ascending Aortic diameter was ≥50 mm in 46/229 patients and 40–49 mm in 52/229 patients. RESULTS: AR was associated with an increased tendency to Aortic media disruption (P< 0.001) and with media degeneration (P< 0.001) compared with AS patients. The incidence of Aortic aneurysm (≥50 mm) was increased in AR patients (35 in AR and 11 in AS, P< 0.01). The Aortic Wall cohesion was better in patients with an Aortic diameter of
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Ascending Aortic Wall Cohesion: Comparison of Bicuspid and Tricuspid Valves
Cardiology research and practice, 2012Co-Authors: Jaroslav Benedik, Kevin Pilarczyk, Daniel Wendt, Jiri Indruch, Radek Flek, Konstantinos Tsagakis, Savvas Alaeddine, Heinz JakobAbstract:Objectives. Bicuspid Aortic valve (AV) represents the most common form of congenital AV malformation, which is frequently associated with pathologies of the ascending aorta. We compared the mechanical properties of the Aortic Wall between patients with bicuspid and tricuspid AV using a new custom-made device mimicking transversal Aortic Wall shear stress. Methods. Between 03/2010 and 07/2011, 190 consecutive patients undergoing open Aortic valve replacement at our institution were prospectively enrolled, presenting either with a bicuspid (group 1,
Simon W. Rabkin - One of the best experts on this subject based on the ideXlab platform.
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Aortic Wall Stress in Hypertension and Ascending Thoracic Aortic Aneurysms: Implications for Antihypertensive Therapy
High Blood Pressure & Cardiovascular Prevention, 2013Co-Authors: Simon W. Rabkin, Michael T. JanuszAbstract:The objective of this study was the evaluation of Aortic Wall stress in patients with ascending thoracic Aortic aneurysms (TAA) because of the paucity of data to guide medical therapy for blood pressure (BP) management in TAA. Twelve men, age 67.4 ± 3.3 years (SEM) with hypertension and ascending TAA without other etiology, previous Aortic surgery or associated significant Aortic valve disease, had maximum dimensions of the ascending aorta measured from CT angiogram (CTa) and transthoracic echocardiogram (TTE) with Aortic Wall thickness measured on TTE. Wall stress (WS(σ)(P)) at peak systolic BP (SBP) was expressed by the equation: WS(σ)(P) = 2LCSA × SBP/MCSA, where LCSA is ascending aorta luminal cross-sectional area; MCSA is the surface area of the Aortic Wall cross sectional area considering Aortic Wall thickness. There was no significant difference in Wall stress from TTE or CTa although mean Wall stress was slightly larger when calculated from CTa. For each 5 mmHg increment in Systolic BP (SBP), there was a 3.9 kPa increase in Wall stress that was 3.5 kPa for small aneurysms (40 to
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Aortic Wall stress in hypertension and ascending thoracic Aortic aneurysms implications for antihypertensive therapy
Annual Review of Physiology, 2013Co-Authors: Simon W. Rabkin, Michael T. JanuszAbstract:The objective of this study was the evaluation of Aortic Wall stress in patients with ascending thoracic Aortic aneurysms (TAA) because of the paucity of data to guide medical therapy for blood pressure (BP) management in TAA. Twelve men, age 67.4 ± 3.3 years (SEM) with hypertension and ascending TAA without other etiology, previous Aortic surgery or associated significant Aortic valve disease, had maximum dimensions of the ascending aorta measured from CT angiogram (CTa) and transthoracic echocardiogram (TTE) with Aortic Wall thickness measured on TTE. Wall stress (WS(σ)(P)) at peak systolic BP (SBP) was expressed by the equation: WS(σ)(P) = 2LCSA × SBP/MCSA, where LCSA is ascending aorta luminal cross-sectional area; MCSA is the surface area of the Aortic Wall cross sectional area considering Aortic Wall thickness. There was no significant difference in Wall stress from TTE or CTa although mean Wall stress was slightly larger when calculated from CTa. For each 5 mmHg increment in Systolic BP (SBP), there was a 3.9 kPa increase in Wall stress that was 3.5 kPa for small aneurysms (40 to <45 mm) and 4.4 kPa for larger aneurysms (45–52 mm). There was a 33.0 ± 1.2 % reduction in Wall stress when SBP went from 165 to 110 mmHg with a 21.0 ± 0.7 % reduction in Wall stress found when SBP was reduced from 140 to 110 mmHg. These data, in patients with hypertension and ascending TAA suggest that meaningful reductions in Aortic Wall stress occur with reductions of SBP and this benefit extends to SBP levels <140 mmHg.
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Aortic valve sclerosis is associated with an echocardiographically determined thinner Aortic Wall.
The Journal of heart valve disease, 2006Co-Authors: Simon W. Rabkin, John Jue, Michael TsangAbstract:BACKGROUND AND AIM OF THE STUDY: The Aortic valve leaflets plus the aorta and sinuses of Valsalva are a functional unit that optimizes distribution of the diastolic pressure load on the Aortic valve leaflets. The study aim was to examine the hypothesis that echocardiographically measured parameters of Aortic Wall stress at the level of the sinuses of Valsalva, namely Aortic Wall thickness and luminal diameter, are associated with the presence of Aortic valve sclerosis (AVS). METHODS: Among 103 patients (age range 60-70 years) referred for echocardiography at a university hospital, 59 with AVS were compared to an age-matched control group (n = 44) with no echocardiographic abnormalities. Subjects with congenital bicuspid Aortic valves were excluded from the study. Transthoracic echocardiographically obtained digital loop recordings were reviewed and two-dimensionally guided measurements were made at the level of the Aortic annulus and sinus of Valsalva using electronic calipers, from the parasternal long-axis view. RESULTS: There was a significant linear relationship and direct correlation between Aortic root diameter at the sinus of Valsalva and body surface area (BSA) (r = 0.488, F = 31.6, p < 0.001) in both the AVS (r = 0.491, F = 18.1, p < 0.001) and control (r = 0.571; F = 20.3; p < 0.001) groups. After adjusting for BSA, Aortic Wall thickness was significantly (p < 0.05) smaller in AVS patients compared to controls. Luminal diameter was not significantly different between the two groups. The specificity of the relationship with sinus of Valsalva Wall thickness was confirmed by an absence of any difference in Aortic root thickness at the level of the Aortic annulus in AVS compared to controls. CONCLUSION: AVS is associated with a thinner Aortic Wall at the level of the sinus of Valsalva. This novel finding suggests that a thinner Aortic Wall, a reflection of its constituents, likely acting through its contribution to reduced Aortic compliance and increased Aortic stress, leads to the thickening of Aortic valve leaflets characteristic of AVS. Further understanding of this relationship may unravel the pathophysiology of this type of Aortic valve disease.