Effects of Aneurysm on the Mechanical Properties and Histologic Structure of Aortic Sinuses Eleftherios P. Kritharis, PhD, Dimitrios C. Iliopoulos, MD,

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University of Pittsburgh Vascular Bioengineering Laboratory Departments of Surgery and Bioengineering and the McGowan Institute for Regenerative Medicine.

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Effects of Aneurysm on the Mechanical Properties and Histologic Structure of Aortic Sinuses Eleftherios P. Kritharis, PhD, Dimitrios C. Iliopoulos, MD, Stavroula A. Papadodima, MD, Dimitrios P. Sokolis, PhD The Annals of Thoracic Surgery Volume 98, Issue 1, Pages 72-79 (July 2014) DOI: 10.1016/j.athoracsur.2014.03.016 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Close-view photographs of a typical sinus specimen under (A) zero load and (B) moderate load, while mounted into the grips of the uniaxial tensile tester. Shown also are the piezoelectric crystals glued on the specimen's middle section for monitoring its elongation during testing. The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 No-load thickness of fresh tissue from aneurysmal subjects (black bars) and control subjects (gray bars) for (A) young group and (B) old group. †‡Significant differences against control and old, respectively. Inside parentheses are the number of specimens used for thickness measurement. (LCS = left coronary sinus; NCS = noncoronary sinus; RCS = right coronary sinus.) The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Typical Cauchy stress-stretch curves of (A) aneurysmal specimens and (B) control specimens in the circumferential (CIRC) and longitudinal (LONG) directions derived from the noncoronary sinus (NCS) of young and old subjects. Failure stress (σf) and stretch (εf) are marked with dotted lines, and peak elastic modulus (Mp) is marked with a triangle denoting slope. Fung-type model predictions are plotted with thick lines. (Thin black lines = experimental data CIRC young; thick black lines = curve fit CIRC young; thin gray lines = experimental data LONG young; thick gray lines = curve fit LONG young; thin red lines = experimental data CIRC old; thick red lines = curve fit CIRC old; thin green lines = experimental data LONG old; thick green lines = curve fit LONG old.) The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A, B) Failure stress and (C, D) peak elastic modulus of aneurysmal and control specimens from the left coronary sinus (LCS), right coronary sinus (RCS), and noncoronary sinus (NCS). Specimens are further categorized as young and old. †‡*§Significant differences against control, old, longitudinal (LONG), and NCS, respectively. Inside parentheses are the number of specimens used for determining failure properties. (Black bars = aneurysmal CIRC; white bars = aneurysmal LONG; dark gray bars = control CIRC; light gray bars = control LONG.) The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A, B) Elastin and (C, D) collagen contents in the entire wall of circumferential (CIRC) and longitudinal (LONG) left coronary sinus (LCS), right coronary sinus (RCS), and noncoronary sinus (NCS) sections from aneurysmal and control subjects for young and old subjects. †‡*Significant differences against control, old, and LONG specimens, respectively. Inside parentheses are the number of specimens used for content measurements. (Black bars = aneurysmal CIRC; white bars = aneurysmal LONG; dark gray bars = control CIRC; light gray bars = control LONG.) The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Orcein-stained sections from the aneurysmal (left) and control (right) right coronary sinus of old subjects. (A, B) Circumferential (CIRC) sections. (C, D) Longitudinal (LONG) sections. Magnification is ×10, with higher magnification (×40) of the rectangular region shown in the insets. The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Sirius-red-stained sections from the aneurysmal (left) and control (right) right coronary sinus of old subjects. (A, B) Circumferential (CIRC) sections. (C, D) Longitudinal (LONG) sections. Magnification is ×10, with higher magnification (×40) of the rectangular region shown in the insets. The Annals of Thoracic Surgery 2014 98, 72-79DOI: (10.1016/j.athoracsur.2014.03.016) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions