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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Chinawa JM, Chukwu B, Chinawa A. Estimation of z-scores of cardiac structures in healthy children in Southeast Nigeria. Ir J Med Sci 2024; 193:689-698. [PMID: 37861940 DOI: 10.1007/s11845-023-03542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The z-scoring system shows the mean deviation of cardiac dimensions from age-specific population. The use of the European-based z-score studies has resulted in misdiagnosis and late treatment of Nigerian children with heart diseases leading to increased mortality and morbidity. OBJECTIVES This study aimed to determine the z‑scores for various cardiac structures and functions among healthy children in Southeast Nigeria. MATERIALS AND METHODS This is a cross-sectional observational study where z-scores of the cardiac structure and function of three hundred healthy children were estimated using echocardiography and compared with the standard Detroit values. RESULT There was a significant positive correlation between age and cardiac valve diameter. The aortic valve strongly correlated positively with age with the Pearson correlation coefficient (ρ) of 0.8 and probability value (P-value) of 0.00. None of the ventricular function variables deviated beyond the +2 or -2 z-score. There was a positive correlation between the z-scores of ventricular function parameters and participants' age, although the strength of the correlation varied. Comparing these values with that of Detroit values, there was a significant difference in the deviation of the mean of the mitral valve and left pulmonary artery diameters from the Detroit values between the males and the females. While the mean z-score mitral valve was 0.8 in males, it was 0.6 in females (P = 0.02). CONCLUSION Z-scores of cardiac structures and function are derived from children in this locale. These values were similar to that of Detroit values except for the mitral valve and left pulmonary artery.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Bartholomew Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Awoere Chinawa
- Department of Community Medicine, ESUCOM, Parklane, Enugu, Nigeria
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3
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Bradley TJ. Personalizing Aortic Surveillance in Paediatric Loeys-Dietz Syndrome. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2024; 3:55-56. [PMID: 38774677 PMCID: PMC11103036 DOI: 10.1016/j.cjcpc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/24/2024]
Affiliation(s)
- Timothy J. Bradley
- Division of Cardiology, Department of Pediatrics, Jim Pattison Children’s Hospital, and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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4
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Hunter-Adamson L, Tierney S. Echogenomics: Echocardiography in Heritable Aortopathies. Curr Cardiol Rep 2024; 26:179-189. [PMID: 38372858 DOI: 10.1007/s11886-024-02024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the current echocardiographic considerations in the diagnosis and monitoring of patients with inherited aortopathies. RECENT FINDINGS Aortic dilation is a key feature in heritable aortopathies, and dissection is a leading cause of morbidity and mortality. New genetic and histopathologic findings are helpful in better understanding these conditions. Non-invasive imaging modalities, including echocardiogram, computerized tomography, and magnetic resonance imaging, are essential in monitoring these patients, as well as providing new prognostic factors of arterial stiffness that may help with risk stratification in the future. Diagnosis of heritable aortopathies should be considered with identification of aortic root dilation, particularly in children and young adults, or when there is a family history of aortic disease. Recent adult consensus guidelines highlight the importance of underlying genotype and phenotypic features when considering prophylactic surgical intervention. There are currently no consensus pediatric guidelines.
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Affiliation(s)
- Lyndsey Hunter-Adamson
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94304, USA
| | - Seda Tierney
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94304, USA.
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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Sengupta A, Carreon CK, Gauvreau K, Lee JM, Sanders SP, Colan SD, Del Nido PJ, Mayer JE, Nathan M. Growth of the Neo-Aortic Root and Prognosis of Transposition of the Great Arteries. J Am Coll Cardiol 2024; 83:516-527. [PMID: 37939977 DOI: 10.1016/j.jacc.2023.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Neo-aortic root dilatation can lead to significant late morbidity after the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA). OBJECTIVES We sought to examine the growth of the neo-aortic root in d-TGA. METHODS A single-center, retrospective cohort study of patients who underwent the ASO between July 1, 1981 and September 30, 2022 was performed. Morphology was categorized as dextro-transposition of the great arteries with intact ventricular septum (d-TGA-IVS), dextro-transposition of the great arteries with ventricular septal defect (d-TGA-VSD), and double-outlet right ventricle-transposition of the great arteries type (DORV-TGA). Echocardiographically determined diameters and derived z scores were measured at the annulus, sinus of Valsalva, and sinotubular junction immediately before the ASO and throughout follow-up. Trends in root dimensions over time were assessed using linear mixed-effects models. The association between intrinsic morphology and the composite of moderate-severe aortic regurgitation (AR) and neo-aortic valve or root intervention was evaluated with univariable and multivariable Cox proportional hazards models. RESULTS Of 1,359 patients who underwent the ASO, 593 (44%), 666 (49%), and 100 (7%) patients had d-TGA-IVS, d-TGA-VSD, and DORV-TGA, respectively. Each patient underwent a median of 5 echocardiograms (Q1-Q3: 3-10 echocardiograms) over a median follow-up of 8.6 years (range: 0.1-39.3 years). At 30 years, patients with DORV-TGA demonstrated greater annular (P < 0.001), sinus of Valsalva (P = 0.039), and sinotubular junction (P = 0.041) dilatation relative to patients with d-TGA-IVS. On multivariable analysis, intrinsic anatomy, older age at ASO, at least mild AR at baseline, and high-risk root dilatation were associated with moderate-severe AR and neo-aortic valve or root intervention at late follow-up (all P < 0.05). CONCLUSIONS Longitudinal surveillance of the neo-aortic root is warranted long after the ASO.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Chrystalle Katte Carreon
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ji M Lee
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephen P Sanders
- The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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8
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Lenz A, Warncke M, Wright F, Weinrich JM, Schoennagel BP, Henes FO, Adam G, von Kodolitsch Y, Schoen G, Bannas P. Longitudinal follow-up by MR angiography reveals progressive dilatation of the distal aorta after aortic root replacement in Marfan syndrome. Eur Radiol 2023; 33:6984-6992. [PMID: 37160424 PMCID: PMC10511572 DOI: 10.1007/s00330-023-09684-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To define and compare growth rates of the distal aorta in Marfan patients with and without aortic root replacement using serial MR angiography (MRA). METHODS We retrospectively included 136 Marfan patients with a total of 645 MRAs who underwent a median of five MRAs (range: 2-13) at 1.5 T and 3 T in annual intervals. Of these, 41 patients (34.8 ± 12 years) had undergone aortic root replacement. The remaining 95 patients (29.0 ± 17 years) still had a native aorta and served as the control group. Thoracic aortic diameters were independently measured at eleven predefined levels. Estimated growth rates were calculated using a mixed effects model adjusted for sex, age, BMI, and medication. RESULTS Marfan patients with aortic root replacement revealed the highest mean estimated growth rate in the proximal descending aorta (0.77 mm/year, CI: 0.31-1.21). Mean growth rates at all levels of the distal thoracic aorta were significantly higher in patients with aortic root replacement (0.28-0.77 mm/year) when compared to patients without aortic root replacement (0.03-0.07 mm/year) (all p < 0.001). Antihypertensive medication, gender, and BMI had no significant impact on the distal aortic growth rates. CONCLUSION Distal thoracic aortic diameters increase at a significantly higher rate in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. Further studies are warranted to investigate if the increased growth rate of the distal thoracic aorta after aortic root replacement is caused by altered hemodynamics due to the rigid aortic root graft or due to the general genetic disposition of post-operative Marfan patients. CLINICAL RELEVANCE STATEMENT High growth rates of the distal aorta after aortic root replacement underline the need for careful life-long aortic imaging of Marfan patients after aortic root replacement. KEY POINTS • Aortic growth rates in Marfan patients with aortic root replacement are highest in the mid-aortic arch, the proximal- and mid-descending aorta. • Growth rates of the distal thoracic aorta are significantly higher in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. • Antihypertensive medication, gender, and BMI have no significant impact on distal aortic growth rates in Marfan patients.
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Affiliation(s)
- Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Malte Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Felicia Wright
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, BG Hospital Hamburg, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiovascular Medicine, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Gerhard Schoen
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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9
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Asta L, D’Angelo GA, Marinelli D, Benedetto U. Genetic Basis, New Diagnostic Approaches, and Updated Therapeutic Strategies of the Syndromic Aortic Diseases: Marfan, Loeys-Dietz, and Vascular Ehlers-Danlos Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6615. [PMID: 37623198 PMCID: PMC10454608 DOI: 10.3390/ijerph20166615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
Syndromic aortic diseases (SADs) encompass various pathological manifestations affecting the aorta caused by known genetic factors, such as aneurysms, dissections, and ruptures. However, the genetic mutation underlying aortic pathology also gives rise to clinical manifestations affecting other vessels and systems. As a consequence, the main syndromes currently identified as Marfan, Loeys-Dietz, and vascular Ehlers-Danlos are characterized by a complex clinical picture. In this contribution, we provide an overview of the genetic mutations currently identified in order to have a better understanding of the pathogenic mechanisms. Moreover, an update is presented on the basis of the most recent diagnostic criteria, which enable an early diagnosis. Finally, therapeutic strategies are proposed with the goal of improving the rates of patient survival and the quality of life of those affected by these SADs.
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Affiliation(s)
- Laura Asta
- Department of Cardiac Surgery, Tor Vergata University Hospital, 00133 Rome, Italy
| | - Gianluca A. D’Angelo
- Department of Cardiac Surgery, SS Annunziata Hospital, 66100 Chieti, Italy; (G.A.D.); (D.M.); (U.B.)
| | - Daniele Marinelli
- Department of Cardiac Surgery, SS Annunziata Hospital, 66100 Chieti, Italy; (G.A.D.); (D.M.); (U.B.)
| | - Umberto Benedetto
- Department of Cardiac Surgery, SS Annunziata Hospital, 66100 Chieti, Italy; (G.A.D.); (D.M.); (U.B.)
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10
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van Elsäcker E, Vink AS, Menke LA, Pals G, Bokenkamp R, Backx ACPM, Hilhorst-Hofstee Y, Blom NA, van der Hulst AE. Growth of the aortic root in children and young adults with Marfan syndrome. Open Heart 2022; 9:openhrt-2022-002097. [PMID: 36543362 PMCID: PMC9772687 DOI: 10.1136/openhrt-2022-002097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The primary aim was to gain insight into the growth of the aortic root in children and young adults with Marfan syndrome (MFS). Furthermore, we aimed to identify a clinical profile of patients with MFS who require an aortic root replacement at a young age with specific interest in age, sex, height and fibrillin-1 (FBN1) genotype. METHODS Aortic root dimensions of 97 patients with MFS between 0 year and 20 years and 30 controls were serially assessed with echocardiography. Trends were analysed using a linear mixed-effect model. Additionally, including only patients with MFS, we allowed trends to differ by sex, aortic root replacement and type of FBN1 mutation. RESULTS Average aortic root dilatation in patients with MFS became more pronounced after the age of 8 years. In the MFS cohort, male patients had a significantly greater aortic root diameter than female patients, which was in close relationship with patient height. There was no difference in aortic root growth between children with dominant negative (DN) or haploinsufficient FBN1 mutations. However, DN-FBN1 variants resulting in loss of cysteine content were associated with a more severe phenotype. Eleven children needed an aortic root replacement. Compared with patients with MFS without aortic root surgery, these children had a significantly larger aortic root diameter from an early age. CONCLUSIONS This study provides clinically useful longitudinal growth charts on aortic root growth in children and young adults with MFS. Children requiring prophylactic aortic root replacement during childhood can be identified at a young age. Our growth charts can help clinicians in decision making with regard to follow-up and prophylactic therapy. Loss of cysteine content in the FBN1 protein was associated with larger aortic root dimensions.
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Affiliation(s)
- Elroy van Elsäcker
- Paediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arja S Vink
- Paediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands,Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Leonie A Menke
- Pediatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gerard Pals
- Clinical Genetics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Regina Bokenkamp
- Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ad C P M Backx
- Paediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Nicolaas A Blom
- Paediatric Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands,Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 430] [Impact Index Per Article: 215.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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12
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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13
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van den Bersselaar LM, Verhagen JMA, Bekkers JA, Kempers M, Houweling AC, Baars M, Overwater E, Hilhorst-Hofstee Y, Barge-Schaapveld DQCM, Rompen E, Krapels IPC, Dulfer E, Wessels MW, Loeys BL, Verhagen HJM, Maugeri A, Roos-Hesselink JW, Brüggenwirth HT, van de Laar IMBH. Expanding the genetic and phenotypic spectrum of ACTA2-related vasculopathies in a Dutch cohort. Genet Med 2022; 24:2112-2122. [PMID: 36053285 DOI: 10.1016/j.gim.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Heterozygous pathogenic/likely pathogenic (P/LP) variants in the ACTA2 gene confer a high risk for thoracic aortic aneurysms and aortic dissections. This retrospective multicenter study elucidates the clinical outcome of ACTA2-related vasculopathies. METHODS Index patients and relatives with a P/LP variant in ACTA2 were included. Data were collected through retrospective review of medical records using a standardized questionnaire. RESULTS A total of 49 individuals from 28 families participated in our study. In total, 20 different ACTA2 variants were detected. Aortic events occurred in 65% of the cases (78.6% index patients and 47.6% relatives). Male sex and hypertension emerged as significantly associated with aortic events. Of 20 individuals, 5 had an aortic diameter of <45 mm (1.77 inches) at the time of the type A dissection. Mean age at first aortic event was 49.0 ± 12.4 years. Severe surgical complications for type A and type B dissection occurred in 25% and 16.7% of the cases and in-hospital mortality rates were 9.5% and 0%, respectively. CONCLUSION P/LP ACTA2 variants are associated with an increased risk for an aortic event and age-related penetrance, which emphasizes the importance of early recognition of the disease. Caregivers should be aware of the risk for aortic dissections, even in individuals with aortic diameters within the normal range.
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Affiliation(s)
- Lisa M van den Bersselaar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marlies Kempers
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjan C Houweling
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marieke Baars
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eline Overwater
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Eline Rompen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Eelco Dulfer
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bart L Loeys
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alessandra Maugeri
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hennie T Brüggenwirth
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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14
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Joo PY, Caruana DL, Gouzoulis MJ, Moore HG, Zhu JR, Ameri B, Grauer JN. Marfan syndrome and adolescent idiopathic scoliosis patients have similar 90-day postoperative outcomes and 5-year reoperation rates after spinal deformity surgery. Spine Deform 2022; 10:1169-1174. [PMID: 35362940 DOI: 10.1007/s43390-022-00501-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Outcomes after spinal deformity surgery in patients with Marfan syndrome (MFS) are poorly characterized given the rarity of the condition. Updated analyses from nationally representative samples, and comparison to outcomes after more commonly performed procedures for conditions such as adolescent idiopathic scoliosis (AIS) could help define the relative risks. METHODS Using the 2010-2020 PearlDiver administrative databases, patients who underwent posterior spinal fusion for > 7 segments were extracted. MFS patients were matched 1:4 to AIS patients based on age, sex, and Elixhauer comorbidity index (ECI). Ninety-day outcomes and 5-year reoperation rates were compared. Significance was set at p < 0.05. RESULTS In total, 206 MFS patients were matched to 825 AIS patients. After adjusting for age, sex, and ECI, multivariate odds ratios (OR) for 90-day any, serious, and minor adverse events, as well as readmissions, were not significantly different for those with MFS compared to those with AIS (p > 0.05 for each). Five-year reoperation rates were also not significantly different (13.1% for the MFS cohort and 13.0% for the AIS cohort (no difference by log-rank, p = 0.9). CONCLUSION While deformity surgery is much less commonly performed for MFS than AIS, it is not uncommonly considered for patients with this condition. Despite some known technical challenges for MFS deformity surgery, the current study leveraged a large, national database to find that 90-day adverse events and 5-year reoperations were not different for matched MFS and AIS patients undergoing deformity surgery. For select patients, these findings should be useful for surgical planning and patient counseling.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Dennis L Caruana
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Harold G Moore
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Bijan Ameri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT, 06510, USA.
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15
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Comparability of different Z-score equations for aortic root dimensions in children with Marfan syndrome. Cardiol Young 2021; 31:1962-1968. [PMID: 33843540 DOI: 10.1017/s1047951121001311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Aortic root dilation is a major complication of Marfan syndrome and is one of the most important criteria in establishing the diagnosis. Currently, different echocardiographic nomograms are used to calculate aortic root Z-scores. The aim of the present study was to assess the potential differences in aortic root measurements when aortic root Z-scores were obtained in a cohort of paediatric Marfan patients using several published nomograms. METHODS In a cohort of 100 children with Marfan syndrome, Z-scores for aortic root dimensions were calculated according to the nomograms of Pettersen et al, Gautier et al, Colan et al, and Lopez et al. Bland-Altman plots were used to estimate mean differences in Z-scores and to establish limits of agreement. RESULTS The mean Z-score of the sinus of Valsalva for Lopez et al was significantly higher compared to Gautier et al (p < 0.01) and Pettersen et al (p = 0.03). The nomogram of Lopez et al resulted in substantially higher Z-scores in patients with a large sinus of Valsalva diameter. Thirty-five percentage of the studied patients would have a Z-score ≥ 2 using Lopez et al compared to 20% for Pettersen et al, 21% for Gautier et al, and 33% for Colan et al. CONCLUSION The currently available nomograms for calculating Z-scores of aortic dilation in children with Marfan syndrome lead to clinically relevant differences in Z-scores, especially in children with a relative large aortic root diameter. This could have impact on both the diagnosis and treatment of patients with Marfan syndrome.
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16
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Chinawa JM, Chinawa AT, Ossai EN, Chukwu BF, Ndu IK, Asinobi IN. Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria. Malawi Med J 2021; 33:127-134. [PMID: 34777708 PMCID: PMC8560357 DOI: 10.4314/mmj.v33i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations. Objectives The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography. Methods A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls. Results A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001). All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005). Conclusion This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Awore T Chinawa
- Consultant Community Physician and Lecturer Enugu state University Teaching hospital, Enugu State
| | - Edmund N Ossai
- Department of community Medicine College of Health Sciences Ebonyi State University Abakaliki, Nigeria
| | - Bartholomew F Chukwu
- Department of Paediatrics, College of Medicine, University of Nigeria Enugu Campus, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, Enugu state University Teaching hospital, Enugu State
| | - Isaac N Asinobi
- Department of Paediatrics, Enugu state University Teaching hospital, Enugu State
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17
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Abstract
Marfan syndrome (MFS) is an autosomal dominant, age-related but highly penetrant condition with substantial intrafamilial and interfamilial variability. MFS is caused by pathogenetic variants in FBN1, which encodes fibrillin-1, a major structural component of the extracellular matrix that provides support to connective tissues, particularly in arteries, the pericondrium and structures in the eye. Up to 25% of individuals with MFS have de novo variants. The most prominent manifestations of MFS are asymptomatic aortic root aneurysms, aortic dissections, dislocation of the ocular lens (ectopia lentis) and skeletal abnormalities that are characterized by overgrowth of the long bones. MFS is diagnosed based on the Ghent II nosology; genetic testing confirming the presence of a FBN1 pathogenetic variant is not always required for diagnosis but can help distinguish MFS from other heritable thoracic aortic disease syndromes that can present with skeletal features similar to those in MFS. Untreated aortic root aneurysms can progress to life-threatening acute aortic dissections. Management of MFS requires medical therapy to slow the rate of growth of aneurysms and decrease the risk of dissection. Routine surveillance with imaging techniques such as transthoracic echocardiography, CT or MRI is necessary to monitor aneurysm growth and determine when to perform prophylactic repair surgery to prevent an acute aortic dissection.
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18
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Weininger G, Chan SM, Zafar M, Ziganshin BA, Elefteriades JA. Risk reduction and pharmacological strategies to prevent progression of aortic aneurysms. Expert Rev Cardiovasc Ther 2021; 19:619-631. [PMID: 34102944 DOI: 10.1080/14779072.2021.1940958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION While size thresholds exist to determine when aortic aneurysms warrant surgical intervention, there is no consensus on how best to treat this disease before aneurysms reach the threshold for intervention. Since a landmark study in 1994 first suggested ß-blockers may be useful in preventing aortic aneurysm growth, there has been a surge in research investigating different pharmacologic therapies for aortic aneurysms - with very mixed results. AREAS COVERED We have reviewed the existing literature on medical therapies used for thoracic and abdominal aortic aneurysms in humans. These include ß-blockers, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors as well as miscellaneous drugs such as tetracyclines, macrolides, statins, and anti-platelet medications. EXPERT OPINION While multiple classes of drugs have been explored for risk reduction in aneurysm disease, with few exceptions results have been disappointing with an abundance of contradictory findings. The vast majority of studies have been done in patients with abdominal aortic aneurysms or thoracic aortic aneurysm patients with Marfan Syndrome. There exists a striking gap in the literature when it comes to pharmacologic management of non-Marfan Syndrome patients with thoracic aortic aneurysms. Given the differences in pathogenesis, this is an important future direction for aortic aneurysm research.
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Affiliation(s)
- Gabe Weininger
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Shin Mei Chan
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Mohammad Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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19
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Malik AH, Yandrapalli S, Pemmasani G, Malik SS, Aronow WS. Pharmacotherapeutics for prevention of aortic root enlargement in Marfan Syndrome - A network meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2020; 27:2187-2190. [PMID: 31487999 DOI: 10.1177/2047487319874907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Srikanth Yandrapalli
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Gayatri Pemmasani
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Senada S Malik
- Divison of Public Health, University of New England, Portland, ME, USA On behalf of MAGIC (Meta-analysis And oriGinal Investigations in Cardiology) investigators
| | - Wilbert S Aronow
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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20
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Pepper J, Izgi C, Golesworthy TJ, Takkenberg JJM, Treasure T. Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm. THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:22. [PMID: 35747770 PMCID: PMC9205243 DOI: 10.5837/bjc.2020.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with congenitally determined aortic root aneurysms are at risk of aortic valve regurgitation, aortic dissection, rupture and death. Personalised external aortic root support (PEARS) may provide an alternative to aortic root replacement. This was a multi-centre, prospective cohort of all consecutive patients who received ExoVasc mesh implants for a dilated aortic root between 2004 and 2017. Baseline and peri-operative characteristics, as well as early postoperative outcomes are described, and time-related survival and re-operation free survival are estimated using the Kaplan-Meier method. From 2004 through 2017, 117 consecutive patients have received ExoVasc mesh implants for aortic root aneurysm. The inclusion criteria were an aortic root/sinus of Valsalva and ascending aorta with asymptomatic dilatation of between 40 and 50 mm in diameter in patients aged 16 years or more. Patients with more than mild aortic regurgitation were excluded. There was one early death. The length of stay was within seven days in 75% of patients. In conclusion, the operation achieves the objectives of valve-sparing root replacement. PEARS may be seen as a low-risk conservative operation, which can be applied earlier on in the disease process, and which is complementary to more invasive procedures, such as valve-sparing root replacement or total root replacement.
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Affiliation(s)
- John Pepper
- Consultant Cardiac Surgeon, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP
| | - Cemil Izgi
- Consultant Cardiac Radiologist, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP
| | - Tal J Golesworthy
- Chartered Energy Engineer, Extent Ltd., Theocsbury House, 18-20 Barton Street, Tewkesbury Gloucestershire
| | - Johanna J M Takkenberg
- Cardiac Epidemiologist, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam The Netherlands
| | - Tom Treasure
- Consultant Cardiothoracic Surgeon, Clinical Operational Research Unit, University College London, 4 Taviton Street, London WC1H 0BT
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21
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Martín C, Evangelista A, Serrano-Fiz S, Villar S, Ospina V, Martínez D, De Villarreal J, Sanchez V, Moñivas V, Mingo S, Forteza A. Aortic Complications in Marfan Syndrome: Should We Anticipate Preventive Aortic Root Surgery? Ann Thorac Surg 2020; 109:1850-1857. [DOI: 10.1016/j.athoracsur.2019.08.096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/27/2019] [Accepted: 08/26/2019] [Indexed: 01/09/2023]
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22
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Coelho SG, Almeida AG. Marfan syndrome revisited: From genetics to the clinic. Rev Port Cardiol 2020; 39:215-226. [PMID: 32439107 DOI: 10.1016/j.repc.2019.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/10/2019] [Accepted: 09/08/2019] [Indexed: 01/16/2023] Open
Abstract
Marfan syndrome is an autosomal dominant connective tissue disease with an estimated incidence of 1 in 5000 individuals. In 90% of cases it is caused by mutations in the gene for fibrillin-1, the main constituent of extracellular microfibrils. Studies on animal models of Marfan syndrome have revealed that fibrillin-1 mutations interfere with local TGF-β signaling, in addition to impairing tissue integrity. The cardinal features involve the cardiovascular, ocular and skeletal systems. The diagnosis of Marfan syndrome is made according to the revised Ghent nosology. Early identification and appropriate management are critical for patients with Marfan syndrome, who are prone to the life-threatening cardiovascular complications of aortic aneurysms and aortic dissection. The standard treatment includes prophylactic beta-blockers in order to slow down dilation of the ascending aorta, and prophylactic aortic surgery. The success of current medical and surgical treatment of aortic disease in Marfan syndrome has substantially improved mean life expectancy, extending it above 72 years. This review aims to provide an overview of this hereditary disorder.
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Affiliation(s)
| | - Ana G Almeida
- Centro Hospitalar de Lisboa Norte, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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23
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Coelho SG, Almeida AG. Marfan syndrome revisited: From genetics to clinical practice. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Patberg E, Duffy J, Hameed AB. Rupture of a Type B Aortic Dissection in a Postpartum Patient with Marfan Syndrome. AJP Rep 2019; 9:e256-e261. [PMID: 31435486 PMCID: PMC6702027 DOI: 10.1055/s-0039-1692712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background Pregnant women with Marfan syndrome (MFS) are known to be at increased risk of aortic dissection; however, cases of aortic rupture are extremely rare. There is lack of consensus on the exact site and size of aortic diameter measurement that increases this risk, and whether this applies to both Type A and Type B dissections. Case A 23-year-old G2P1001 with known Marfan syndrome who underwent an uncomplicated antepartum and intrapartum course. She experienced persistent backache 10 days postpartum that led to the diagnosis of Stanford Type B dissection. The patient was hospitalized for close observation. Dissection progressed to aortic rupture within 24 hours that required emergent thoracic endovascular aortic repair. She had an uncomplicated postoperative course. Conclusion Our report demonstrates rupture of a known aortic dissection within a very short time in the postpartum period. The case highlights the importance of patient education and close surveillance especially in the postpartum period. It also brings home the value of imaging of the whole aorta rather than focusing on the ascending alone. Multidisciplinary care and timely diagnosis and intervention likely led to the favorable outcome in our case.
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Affiliation(s)
- Elizabeth Patberg
- Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, California
| | - Jennifer Duffy
- Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, California
| | - Afshan B Hameed
- Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, California
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25
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Harky A, Bashir M, Antoniou A, Francis N, Alhamdan L, Uppal R. Size and dissection: what is the relation? Indian J Thorac Cardiovasc Surg 2019; 35:72-78. [PMID: 33061069 PMCID: PMC7525749 DOI: 10.1007/s12055-018-0687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022] Open
Abstract
Thoracic aortic aneurysm is a complex disease. The consequences of such silent and indolent disease include acute aortic syndrome if not recognized early and treated appropriately. Aortic aneurysm size was a reliable clinical marker to aid clinical intervention; however, aneurysm growth is variable and is influenced by many factors such as age, presence of connective tissue disorders, genetic disorders, hypertension, inflammatory conditions of the aorta, autoimmune diseases, smoking, and history of previous cardiac surgery. Therefore, aortic size became a non-specific disease surrogate and prediction tool on outcome and intervention. In this review article, we examined the current literature for evidence about aneurysm size and its relation to type A aortic dissection.
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Affiliation(s)
- Amer Harky
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
- Cardiothoracic Surgery, Northwest Deanery, Merseyside, Liverpool, UK
- School of Medicine, University of Cardiff, Cardiff, UK
| | - Mohamad Bashir
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
| | - Athanasios Antoniou
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
| | - Niroshan Francis
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
| | - Loay Alhamdan
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
| | - Rakesh Uppal
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
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26
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Affiliation(s)
- Alan C. Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (A.C.B.)
| | - Mary J. Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R.)
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Cui JZ, Lee L, Sheng X, Chu F, Gibson CP, Aydinian T, Walker DC, Sandor GGS, Bernatchez P, Tibbits GF, van Breemen C, Esfandiarei M. In vivo characterization of doxycycline-mediated protection of aortic function and structure in a mouse model of Marfan syndrome-associated aortic aneurysm. Sci Rep 2019; 9:2071. [PMID: 30765726 PMCID: PMC6376062 DOI: 10.1038/s41598-018-38235-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
Aortic aneurysm is the most life-threatening complication in Marfan syndrome (MFS) patients. Doxycycline, a nonselective matrix metalloproteinases inhibitor, was reported to improve the contractile function and elastic fiber structure and organization in a Marfan mouse aorta using ex vivo small chamber myography. In this study, we assessed the hypothesis that a long-term treatment with doxycycline would reduce aortic root growth, improve aortic wall elasticity as measured by pulse wave velocity, and improve the ultrastructure of elastic fiber in the mouse model of MFS. In our study, longitudinal measurements of aortic root diameters using high-resolution ultrasound imaging display significantly decreased aortic root diameters and lower pulse wave velocity in doxycycline-treated Marfan mice starting at 6 months as compared to their non-treated MFS counterparts. In addition, at the ultrastructural level, our data show that long-term doxycycline treatment corrects the irregularities of elastic fibers within the aortic wall of Marfan mice to the levels similar to those observed in control subjects. Our findings underscore the key role of matrix metalloproteinases during the progression of aortic aneurysm, and provide new insights into the potential therapeutic value of doxycycline in blocking MFS-associated aortic aneurysm.
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Affiliation(s)
- Jason Z Cui
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Cardiothoracic Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Ling Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Xiaoye Sheng
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Fanny Chu
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine P Gibson
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - Taline Aydinian
- Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA
| | - David C Walker
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Pascal Bernatchez
- Department of Anesthesiology, Pharmacology and Therapeutics, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Glen F Tibbits
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Cornelis van Breemen
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Mitra Esfandiarei
- Department of Anesthesiology, Pharmacology and Therapeutics, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada. .,Department of Biomedical Sciences, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA.
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Stark VC, Doering K, von Kodolitsch Y, Kozlik-Feldmann R, Mueller GC, Olfe J, Rybczynski M, Schueler H, Mir TS. The transition of pediatric Marfan patients to adult care: a challenge and its risks. Cardiovasc Diagn Ther 2019; 8:698-704. [PMID: 30740317 DOI: 10.21037/cdt.2018.09.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Care for patients with Marfan syndrome (MFS) has improved substantially in recent decades. Increasing clinical knowledge and genetic analysis allow early diagnosis of the disease in childhood. Because of the earlier initiation to preventive and medical treatment, patients' life expectancy has risen. To ensure optimal care, pediatric patients require a safe follow-up regime, multidisciplinary care, and a safe transition to adult care. Methods We collected a sample of 149 pediatric Marfan patients, of whom 34 patients had already been transferred to adult care or who were currently transitioning. First, we evaluated clinical aspects of patients that manifest in childhood and are present in the transition process. Second, we analyzed the transition process itself. Results We found age-dependent manifestation of organ pathologies. Dilatation of the sinus of Valsalva showed a particularly high prevalence during the transition process and 62% of patients required medical treatment. Mean onset of aortic root dilatation was 9.9±5.8 years. Concerning systemic manifestation in MFS skin striae, wrist and thumb sign, and reduced elbow extension occurred significantly more often in patients who were transitioning than in younger children with MFS. All other clinical Marfan features showed an increased prevalence in patients who were transitioning compared with younger patients. In our cohort, transition was successful in 20 patients (58.9%), 12 patients (35.3%) are still in the transition process and 2 patients (5.9%) were lost to follow up. Conclusions Marfan patients in the transition process are already under a chronic disease condition with a high onset of especially cardiovascular pathologies. Although early medical treatment in childhood is effective, the pathologies of the connective tissue require lifelong attention and influence life in many ways. The big challenge during transition is the double change of responsibility from the parents and pediatric doctor to the patient and adult doctor. Consequently, patients in transition process require special attention and close contact with the doctor and the family. A reevaluation by the supervising pediatric Marfan specialist of the successful transition to adult care is indispensable before the pediatric care of Marfan patients is completed.
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Affiliation(s)
| | - Katrin Doering
- Pediatric Cardiology, University Heart Center, Hamburg, Germany
| | | | | | - Götz C Mueller
- Pediatric Cardiology, University Heart Center, Hamburg, Germany
| | - Jakob Olfe
- Pediatric Cardiology, University Heart Center, Hamburg, Germany
| | | | | | - Thomas S Mir
- Pediatric Cardiology, University Heart Center, Hamburg, Germany
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Wozniak-Mielczarek L, Sabiniewicz R, Drezek-Nojowicz M, Nowak R, Gilis-Malinowska N, Mielczarek M, Łabuc A, Waldoch A, Wierzba J. Differences in Cardiovascular Manifestation of Marfan Syndrome Between Children and Adults. Pediatr Cardiol 2019; 40:393-403. [PMID: 30417312 PMCID: PMC6399167 DOI: 10.1007/s00246-018-2025-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/01/2018] [Indexed: 12/20/2022]
Abstract
Marfan syndrome (MFS) is a connective tissue disorder characterized by a broad range of clinical manifestations. Cardiovascular involvement is the most life-threatening aspect of the syndrome. Although abnormalities within the cardiovascular system in adults are well documented, there is still a paucity of data regarding manifestation of MFS in childhood. The aim of the study was to compare cardiovascular manifestation of MFS between children and adults. The study population consisted of 236 patients (144 children and 92 adults), who were referred to our department with suspicion of MFS. All patients underwent complete clinical evaluation in order to confirm the diagnosis of MFS according to the modified Ghent criteria. MFS was diagnosed in 101 (44 children and 57 adults) out of the 236 patients. The other patients were diagnosed with Ehlers-Danlos syndrome, Loeys-Dietz syndrome, MASS phenotype, ectopia lentis syndrome, marfanoid habitus and other rare syndromes. The most common cardiovascular abnormality was aortic root dilatation (81.19% of patients). It was found that both adults and children had similar high rates of aortic root dilatation. Similarly, there was no significant difference with regard to the prevalence of aortic valve regurgitation and mitral valve prolapse among children and adults. These findings equivocally indicate that the aforementioned abnormalities develop in early childhood, therefore, they may be used in the early identification of patients with MFS. Other assessed abnormalities, which included mitral valve regurgitation, pulmonary artery dilation, aneurysms of aortic arch, descending thoracic aorta and abdominal aorta were found mostly in adults, and thus, are of less use in the early detection of MFS.
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Affiliation(s)
- L. Wozniak-Mielczarek
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Gdansk, Poland
| | - R. Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Gdansk, Poland
| | - M. Drezek-Nojowicz
- Department of Ophthalmology, Medical University of Gdansk, Gdansk, Poland
| | - R. Nowak
- 2nd Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | | | - M. Mielczarek
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - A. Łabuc
- Department of Orthopaedics and Motor Organ Traumatology, Medical University of Gdansk, Gdansk, Poland
| | - A. Waldoch
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Gdansk, Poland
| | - J. Wierzba
- Department of Nursery, Medical University of Gdansk, Gdansk, Poland
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Hoskoppal A, Menon S, Trachtenberg F, Burns KM, De Backer J, Gelb BD, Gleason M, James J, Lai WW, Liou A, Mahony L, Olson AK, Pyeritz RE, Sharkey AM, Stylianou M, Wechsler SB, Young L, Levine JC, Tierney ESS, Lacro RV, Bradley TJ. Predictors of Rapid Aortic Root Dilation and Referral for Aortic Surgery in Marfan Syndrome. Pediatr Cardiol 2018; 39:1453-1461. [PMID: 29948025 PMCID: PMC6150800 DOI: 10.1007/s00246-018-1916-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/31/2018] [Indexed: 01/15/2023]
Abstract
Few data exist regarding predictors of rapid aortic root dilation and referral for aortic surgery in Marfan syndrome (MFS). To identify independent predictors of the rate of aortic root (AoR) dilation and referral for aortic surgery, we investigated the data from the Pediatric Heart Network randomized trial of atenolol versus losartan in young patients with MFS. Data were analyzed from the echocardiograms at 0, 12, 24, and 36 months read in the core laboratory of 608 trial subjects, aged 6 months to 25 years, who met original Ghent criteria and had an AoR z-score (AoRz) > 3. Repeated measures linear and logistic regressions were used to determine multivariable predictors of AoR dilation. Receiver operator characteristic curves were used to determine cut-points in AoR dilation predicting referral for aortic surgery. Multivariable analysis showed rapid AoR dilation as defined by change in AoRz/year > 90th percentile was associated with older age, higher sinotubular junction z-score, and atenolol use (R2 = 0.01) or by change in AoR diameter (AoRd)/year > 90th percentile with higher sinotubular junction z-score and non-white race (R2 = 0.02). Referral for aortic root surgery was associated with higher AoRd, higher ascending aorta z-score, and higher sinotubular junction diameter:ascending aorta diameter ratio (R2 = 0.17). Change in AoRz of 0.72 SD units/year had 42% sensitivity and 92% specificity and change in AoRd of 0.34 cm/year had 38% sensitivity and 95% specificity for predicting referral for aortic surgery. In this cohort of young patients with MFS, no new robust predictors of rapid AoR dilation or referral for aortic root surgery were identified. Further investigation may determine whether generalized proximal aortic dilation and effacement of the sinotubular junction will allow for better risk stratification. Rate of AoR dilation cut-points had high specificity, but low sensitivity for predicting referral for aortic surgery, limiting their clinical use. Clinical Trial Number ClinicalTrials.gov number, NCT00429364.
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Affiliation(s)
| | | | | | - Kristin M Burns
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | - Bruce D Gelb
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marie Gleason
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanne James
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - Aimee Liou
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lynn Mahony
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | | | - Reed E Pyeritz
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | - Luciana Young
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jami C Levine
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ronald V Lacro
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy J Bradley
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Gaudino M, Girardi LN, Rahouma M, Leonard JR, Di Franco A, Lau C, Mehta N, Abouarab A, Schwann AN, Scuderi G, Demetres M, Devereux RB, Benedetto U, Weinsaft JW. Editor's Choice – Aortic Re-operation After Replacement of the Proximal Aorta: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2018; 56:515-523. [DOI: 10.1016/j.ejvs.2018.06.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/16/2018] [Indexed: 12/24/2022]
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Tennyson M. Question 2: In children with Marfan's should we beta block from point of diagnosis? Arch Dis Child 2018; 103:997-1000. [PMID: 30154179 DOI: 10.1136/archdischild-2018-315848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 11/03/2022]
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Robinet P, Milewicz DM, Cassis LA, Leeper NJ, Lu HS, Smith JD. Consideration of Sex Differences in Design and Reporting of Experimental Arterial Pathology Studies-Statement From ATVB Council. Arterioscler Thromb Vasc Biol 2018; 38:292-303. [PMID: 29301789 DOI: 10.1161/atvbaha.117.309524] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022]
Abstract
There are many differences in arterial diseases between men and women, including prevalence, clinical manifestations, treatments, and prognosis. The new policy of the National Institutes of Health, which requires the inclusion of sex as a biological variable for preclinical studies, aims to foster new mechanistic insights and to enhance our understanding of sex differences in human diseases. The purpose of this statement is to suggest guidelines for designing and reporting sex as a biological variable in animal models of atherosclerosis, thoracic and abdominal aortic aneurysms, and peripheral arterial disease. We briefly review sex differences of these human diseases and their animal models, followed by suggestions on experimental design and reporting of animal studies for these vascular pathologies.
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Affiliation(s)
- Peggy Robinet
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Dianna M Milewicz
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Lisa A Cassis
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Nicholas J Leeper
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Hong S Lu
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Jonathan D Smith
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.).
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Urbanski PP, Jankulowski A, Morka A, Irimie V, Zhan X, Zacher M, Diegeler A. Patient-tailored aortic root repair in adult marfanoid patients: Surgical considerations and outcomes. J Thorac Cardiovasc Surg 2018; 155:43-51.e1. [DOI: 10.1016/j.jtcvs.2017.05.108] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/24/2017] [Accepted: 05/29/2017] [Indexed: 02/04/2023]
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Ferrara A, Totaro P, Morganti S, Auricchio F. Effects of clinico-pathological risk factors on in-vitro mechanical properties of human dilated ascending aorta. J Mech Behav Biomed Mater 2018; 77:1-11. [DOI: 10.1016/j.jmbbm.2017.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 12/24/2022]
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36
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Patel AR, Caffarelli A, Pandian NG. Aortic Disorders. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lacolley P, Regnault V, Segers P, Laurent S. Vascular Smooth Muscle Cells and Arterial Stiffening: Relevance in Development, Aging, and Disease. Physiol Rev 2017; 97:1555-1617. [DOI: 10.1152/physrev.00003.2017] [Citation(s) in RCA: 332] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/15/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022] Open
Abstract
The cushioning function of large arteries encompasses distension during systole and recoil during diastole which transforms pulsatile flow into a steady flow in the microcirculation. Arterial stiffness, the inverse of distensibility, has been implicated in various etiologies of chronic common and monogenic cardiovascular diseases and is a major cause of morbidity and mortality globally. The first components that contribute to arterial stiffening are extracellular matrix (ECM) proteins that support the mechanical load, while the second important components are vascular smooth muscle cells (VSMCs), which not only regulate actomyosin interactions for contraction but mediate also mechanotransduction in cell-ECM homeostasis. Eventually, VSMC plasticity and signaling in both conductance and resistance arteries are highly relevant to the physiology of normal and early vascular aging. This review summarizes current concepts of central pressure and tensile pulsatile circumferential stress as key mechanical determinants of arterial wall remodeling, cell-ECM interactions depending mainly on the architecture of cytoskeletal proteins and focal adhesion, the large/small arteries cross-talk that gives rise to target organ damage, and inflammatory pathways leading to calcification or atherosclerosis. We further speculate on the contribution of cellular stiffness along the arterial tree to vascular wall stiffness. In addition, this review provides the latest advances in the identification of gene variants affecting arterial stiffening. Now that important hemodynamic and molecular mechanisms of arterial stiffness have been elucidated, and the complex interplay between ECM, cells, and sensors identified, further research should study their potential to halt or to reverse the development of arterial stiffness.
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Affiliation(s)
- Patrick Lacolley
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
| | - Véronique Regnault
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
| | - Patrick Segers
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
| | - Stéphane Laurent
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
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Roman MJ, Devereux RB, Preiss LR, Asch FM, Eagle KA, Holmes KW, LeMaire SA, Maslen CL, Milewicz DM, Morris SA, Prakash SK, Pyeritz RE, Ravekes WJ, Shohet RV, Song HK, Weinsaft JW. Associations of Age and Sex With Marfan Phenotype: The National Heart, Lung, and Blood Institute GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) Registry. CIRCULATION. CARDIOVASCULAR GENETICS 2017; 10:e001647. [PMID: 28600386 PMCID: PMC5500868 DOI: 10.1161/circgenetics.116.001647] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 04/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The associations of age and sex with phenotypic features of Marfan syndrome have not been systematically examined in a large cohort of both children and adults. METHODS AND RESULTS We evaluated 789 Marfan patients enrolled in the National Heart, Lung, and Blood Institute GenTAC (Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) Registry (53% male; mean age 31 [range: 1-86 years]). Females aged ≥15 and males aged ≥16 years were considered adults based on average age of skeletal maturity. Adults (n=606) were more likely than children (n=183) likely to have spontaneous pneumothorax, scoliosis, and striae but were comparable in revised Ghent systemic score, ectopia lentis, and most phenotypic features, including prevalence of aortic root dilatation. Prophylactic aortic root replacement and mitral valve surgery were rare during childhood versus adulthood (2% versus 35% and 1% versus 9%, respectively, both P<0.0001). Adult males were more likely than females to have aortic root dilatation (92% versus 84%), aortic regurgitation (55% versus 36%), and to have undergone prophylactic aortic root replacement (47% versus 24%), all P<0.001. Prevalence of previous aortic dissection tended to be higher in males than females (25% versus 18%, P=0.06); 44% of dissections were type B. Type B dissection was strongly associated with previous prophylactic aortic root replacement. CONCLUSIONS Pulmonary, skeletal, and aortic complications, but not other phenotypic features, are more prevalent in adults than children in Marfan syndrome. Aortic aneurysms and prophylactic aortic surgery are more common in men. Aortic dissection, commonly type B, occurs in an appreciable proportion of Marfan patients, especially in men and after previous prophylactic aortic root replacement.
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Affiliation(s)
- Mary J Roman
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.).
| | - Richard B Devereux
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Liliana R Preiss
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Federico M Asch
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Kim A Eagle
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Kathryn W Holmes
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Scott A LeMaire
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Cheryl L Maslen
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Dianna M Milewicz
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Shaine A Morris
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Siddharth K Prakash
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Reed E Pyeritz
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - William J Ravekes
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Ralph V Shohet
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Howard K Song
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
| | - Jonathan W Weinsaft
- From the Division of Cardiology, Weill Cornell Medicine, New York, NY (M.J.R., R.B.D., J.W.W.); Biostatistics and Epidemiology Division, RTI International, Rockville, MD (L.R.P.); MedStar Cardiovascular Research Network, Washington, DC (F.M.A.); Division of Cardiology, University of Michigan Health System, Ann Arbor (K.A.E.); Department of Pediatrics (K.W.H.), Division of Cardiothoracic Surgery (H.K.S.), and Knight Cardiovascular Institute (C.L.M.), Oregon Health & Science University, Portland; Division of Cardiothoracic Surgery (S.A.L.) and Division of Pediatric Cardiology, Department of Pediatrics (S.A.M.), Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston (S.A.L.); Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, San Antonio (D.M.M., S.K.P.); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.E.P.); Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD (W.J.R.); and Department of Medicine, John A. Burns School of Medicine, Honolulu, HI (R.V.S.)
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Raffa GM, Kowalewski M, Malvindi PG, Bertani A, Romano G, Sciacca S, Turrisi M, Armaro A, Stringi V, Montalbano G, Mattiucci G, Follis F, Pilato M. Aortic surgery in Marfan patients with severe pectus excavatum. J Cardiovasc Med (Hagerstown) 2017; 18:305-310. [DOI: 10.2459/jcm.0000000000000394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aalaei-Andabili SH, Martin T, Hess P, Klodell C, Karimi A, Arnaoutakis G, Lee T, Beaver T. Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function in Marfan Syndrome Patients. Ann Thorac Surg 2017; 104:834-839. [PMID: 28410640 DOI: 10.1016/j.athoracsur.2017.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/10/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Florida sleeve (FS) procedure was developed as a simplified approach for repair of functional type I aortic insufficiency secondary to aortic root aneurysm. We evaluated postoperative aortic valve function, long-term survival, and freedom from reoperation in Marfan syndrome patients who underwent the FS procedure at our center. METHODS All Marfan syndrome patients undergoing FS procedure from May 2002 to December 2014 were included. Echocardiography assessment included left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), ejection fraction, and degree of aortic insufficiency (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4). Social Security Death Index and primary care physicians' report were used for long-term follow-up. RESULTS Thirty-seven Marfan syndrome patients, 21 (56.8%) men and 16 (43%) women with mean age of 35.08 ± 13.45 years underwent FL repair at our center. There was no in-hospital or 30-day death or stroke. Two patients required reoperation due to bleeding. Patients' survival rate was 94% at 1 to 8 years. Freedom from reoperation was 100% at 8 years. Twenty-five patients had postoperative follow-up echocardiography at 1 week. Aortic insufficiency grade significantly decreased after the procedure (preoperative mean ± SD: 1.76 ± 1.2 versus 1-week postoperative mean ± SD: 0.48 ± 0.71, p < 0.001), and mean LVEDD decreased from 52.23 ± 5.29 mm to 47.53 ± 8.89 mm (p = 0.086). Changes in LVESD (35.33 ± 9.97 mm to 36.58 ± 9.82 mm, p = 0.58) and ejection fraction (57.65% ± 6.22% to 55% ± 10.83%, p = 0.31) were not significant. CONCLUSIONS The FS procedure can be performed safely in Marfan syndrome patients with immediate improvement in aortic valve function. Long-term survival and freedom from reoperation rates are encouraging.
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Affiliation(s)
| | - Tomas Martin
- Division of Thoracic and Cardiovascular Surgery, Florida Hospital Orlando, Orlando, Florida
| | - Philip Hess
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University, Indianapolis, Indiana
| | - Charles Klodell
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Ashkan Karimi
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida
| | - George Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Teng Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Thomas Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
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Abstract
Surgery of the aortic arch is arguably one of the most complex areas of cardiac surgery. Despite that, studies and guidelines have not sufficiently addressed the aortic arch specifically. In general, indications for aortic arch intervention parallel those of the ascending aorta. Herein we review indications for aortic arch intervention in various aortic pathologies based on the scant evidence available combined with surgical expertise and expert opinion.
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Kirali K, Yakut N, Güler M, Mansuroğlu D, Ömeroğlu S, Akinci E, Gürbüz A, Yakut C. Surgical Treatment of Siblings with Marfan Syndrome. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849239900700216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rupture of an ascending aortic aneurysm is the most common cause of death in patients with Marfan syndrome, while type-A aortic dissection is the second most common fatal lesion. The aortic root dimension and the rate at which it increases are the best indications for surgical treatment. We regard aortic enlargement to 5.5 cm as the upper limit of safety and we are inclined to advocate surgery at an earlier stage in high-risk families. We report our results of the surgical management of aortic aneurysm in the two siblings; a third sibling is currently being followed medically.
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Affiliation(s)
- Kaan Kirali
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Necmettin Yakut
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Mustafa Güler
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Denyan Mansuroğlu
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Suat Ömeroğlu
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Esat Akinci
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Ali Gürbüz
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
| | - Cevat Yakut
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital Istanbul, Turkey
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Di Cesare E, Splendiani A, Barile A, Squillaci E, Di Cesare A, Brunese L, Masciocchi C. CT and MR imaging of the thoracic aorta. Open Med (Wars) 2016; 11:143-151. [PMID: 28352783 PMCID: PMC5329815 DOI: 10.1515/med-2016-0028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 03/07/2016] [Indexed: 12/25/2022] Open
Abstract
At present time, both CT and MRI are valuable techniques in the study of the thoracic aorta. Nowadays, CT represents the most widely employed technique for the study of the thoracic aorta. The new generation CTs show sensitivities up to 100% and specificities of 98-99%. Sixteen and wider row detectors provide isotropic pixels, mandatory for the ineludible longitudinal reconstruction. The main limits are related to the X-ray dose expoure and the use of iodinated contrast media. MRI has great potential in the study of the thoracic aorta. Nevertheless, if compared to CT, acquisition times remain longer and movement artifact susceptibility higher. The main MRI disadvantages are claustrophobia, presence of ferromagnetic implants, pacemakers, longer acquisition times with respect to CT, inability to use contrast media in cases of renal insufficiency, lower spatial resolution and less availability than CT. CT is preferred in the acute aortic disease. Nevertheless, since it requires iodinated contrast media and X-ray exposure, it may be adequately replaced by MRI in the follow up of aortic diseases. The main limitation of MRI, however, is related to the scarce visibility of stents and calcifications.
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Affiliation(s)
- Ernesto Di Cesare
- Dipartimento di Scienze Cliniche Applicate e biotecnologiche, Università degli studi di L'Aquila, Via Vetoio 1, 67100 L'Aquila, Italy , Tel 00390862368306, Fax 00390862368797
| | - Alessandra Splendiani
- Dipartimento di Scienze Cliniche Applicate e biotecno-logiche Università degli studi di L'Aquila, Italy
| | - Antonio Barile
- Dipartimento di Scienze Cliniche Applicate e biotecno-logiche Università degli studi di L'Aquila, Italy
| | - Ettore Squillaci
- Dipartimento di Diagnostica per Immagini Universi-tà Tor Vergata Roma, Italy
| | - Annamaria Di Cesare
- Dipartimento di Scienze Cliniche Applicate e biotecno-logiche Università degli studi di L'Aquila, Italy
| | - Luca Brunese
- Dipartimento di medicina e Scienza della salute, Universita del Molise, Campobasso, Italy
| | - Carlo Masciocchi
- Dipartimento di Scienze Cliniche Applicate e biotecno-logiche Università degli studi di L'Aquila, Italy
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Weinsaft JW, Devereux RB, Preiss LR, Feher A, Roman MJ, Basson CT, Geevarghese A, Ravekes W, Dietz HC, Holmes K, Habashi J, Pyeritz RE, Bavaria J, Milewski K, LeMaire SA, Morris S, Milewicz DM, Prakash S, Maslen C, Song HK, Silberbach GM, Shohet RV, McDonnell N, Hendershot T, Eagle KA, Asch FM. Aortic Dissection in Patients With Genetically Mediated Aneurysms: Incidence and Predictors in the GenTAC Registry. J Am Coll Cardiol 2016; 67:2744-2754. [PMID: 27282895 PMCID: PMC5040186 DOI: 10.1016/j.jacc.2016.03.570] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Aortic dissection (AoD) is a serious complication of thoracic aortic aneurysm (TAA). Relative risk for AoD in relation to TAA etiology, incidence, and pattern after prophylactic TAA surgery are poorly understood. OBJECTIVES This study sought to determine the incidence, pattern, and relative risk for AoD among patients with genetically associated TAA. METHODS The population included adult GenTAC participants without AoD at baseline. Standardized core laboratory tests classified TAA etiology and measured aortic size. Follow-up was performed for AoD. RESULTS Bicuspid aortic valve (BAV) (39%) and Marfan syndrome (MFS) (22%) were the leading diagnoses in the studied GenTAC participants (n = 1,991). AoD occurred in 1.6% over 3.6 ± 2.0 years; 61% of AoD occurred in patients with MFS. Cumulative AoD incidence was 6-fold higher among patients with MFS (4.5%) versus others (0.7%; p < 0.001). MFS event rates were similarly elevated versus those in patients with BAV (0.3%; p < 0.001). AoD originated in the distal arch or descending aorta in 71%; 52% of affected patients, including 68% with MFS, had previously undergone aortic grafting. In patients with proximal aortic surgery, distal aortic size (descending thoracic, abdominal aorta) was larger among patients with AoD versus those without AoD (both p < 0.05), whereas the ascending aorta size was similar. Conversely, in patients without previous surgery, aortic root size was greater in patients with subsequent AoD (p < 0.05), whereas distal aortic segments were of similar size. MFS (odds ratio: 7.42; 95% confidence interval: 3.43 to 16.82; p < 0.001) and maximal aortic size (1.86 per cm; 95% confidence interval: 1.26 to 2.67; p = 0.001) were independently associated with AoD. Only 4 of 31 (13%) patients with AoD had pre-dissection images that fulfilled size criteria for prophylactic TAA surgery at a subsequent AoD site. CONCLUSIONS Among patients with genetically associated TAA, MFS augments risk for AoD even after TAA grafting. Although increased aortic size is a risk factor for subsequent AoD, events typically occur below established thresholds for prophylactic TAA repair.
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Affiliation(s)
| | | | - Liliana R Preiss
- Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland
| | - Attila Feher
- Weill Cornell Medical College, New York, New York
| | - Mary J Roman
- Weill Cornell Medical College, New York, New York
| | | | | | - William Ravekes
- Department of Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Harry C Dietz
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kathryn Holmes
- Department of Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer Habashi
- Department of Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Reed E Pyeritz
- Division of Medical Genetics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karianna Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine and the Texas Heart Institute, Houston, Texas
| | - Shaine Morris
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Dianna M Milewicz
- Division of Medical Genetics, University of Texas Health Sciences Center, Houston, Texas
| | - Siddharth Prakash
- Division of Medical Genetics, University of Texas Health Sciences Center, Houston, Texas
| | - Cheryl Maslen
- Heart Research Center, Oregon Health & Sciences University, Portland, Oregon
| | - Howard K Song
- Division of Cardiothoracic Surgery, Oregon Health & Sciences University, Portland, Oregon
| | - G Michael Silberbach
- Department of Pediatric Cardiology, Oregon Health & Sciences University, Portland, Oregon
| | - Ralph V Shohet
- Division of Cardiovascular Research, Queens Medical Center, Honolulu, Hawaii
| | - Nazli McDonnell
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Tabitha Hendershot
- Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland
| | - Kim A Eagle
- Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Federico M Asch
- Cardiovascular Core Laboratory, MedStar Health Research Institute at Washington Hospital Center, Washington, DC
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Jessurun CAC, Bom DAM, Franken R. An update on the pathophysiology, treatment and genetics of Marfan syndrome. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1184083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Long-term outcomes of aortic root operations for Marfan syndrome: A comparison of Bentall versus aortic valve-sparing procedures. J Thorac Cardiovasc Surg 2016; 151:330-6. [DOI: 10.1016/j.jtcvs.2015.10.068] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/23/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Forteza A, Evangelista A, Sánchez V, Teixidó-Turà G, Sanz P, Gutiérrez L, Gracia T, Centeno J, Rodríguez-Palomares J, Rufilanchas JJ, Cortina J, Ferreira-González I, García-Dorado D. Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial. Eur Heart J 2015; 37:978-85. [DOI: 10.1093/eurheartj/ehv575] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 10/06/2015] [Indexed: 01/16/2023] Open
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Andelfinger G, Loeys B, Dietz H. A Decade of Discovery in the Genetic Understanding of Thoracic Aortic Disease. Can J Cardiol 2015; 32:13-25. [PMID: 26724507 DOI: 10.1016/j.cjca.2015.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 12/23/2022] Open
Abstract
Aortic aneurysms are responsible for a significant number of all deaths in Western countries. In this review we provide a perspective on the important progress made over the past decade in the understanding of the genetics of this condition, with an emphasis on the more frequent forms of vascular smooth muscle and transforming growth factor β (TGF-β) signalling alterations. For several nonsyndromic and syndromic forms of thoracic aortic disease, a genetic basis has now been identified, with 3 main pathomechanisms that have emerged: perturbation of the TGF-β signalling pathway, disruption of the vascular smooth muscle cell (VSMC) contractile apparatus, and impairment of extracellular matrix synthesis. Because smooth muscle cells and proteins of the extracellular matrix directly regulate TGF-β signalling, this latter pathway emerges as a key component of thoracic aortic disease initiation and progression. These discoveries have revolutionized our understanding of thoracic aortic disease and provided inroads toward gene-specific stratification of treatment. Last, we outline how these genetic findings are translated into novel pharmaceutical approaches for thoracic aortic disease.
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Affiliation(s)
- Gregor Andelfinger
- Cardiovascular Genetics, Department of Pediatrics, Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
| | - Bart Loeys
- Centre for Medical Genetics, University Hospital of Antwerp/University of Antwerp, Antwerp, Belgium; Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hal Dietz
- Howard Hughes Medical Institute and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Normal Values and Differences in Ascending Aortic Diameter in a Healthy Population of Adults as Measured by the Pediatric versus Adult American Society of Echocardiography Guidelines. J Am Soc Echocardiogr 2015; 29:166-72. [PMID: 26601702 DOI: 10.1016/j.echo.2015.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is a lack of uniformity across echocardiographic society guidelines as to how the diameter of the ascending aorta is to be measured. The aims of this study were to compare measurements done using the diastolic leading edge-to-leading edge and systolic inner edge-to-inner edge (SIE) techniques in a large cohort of healthy adult individuals and to report the normal values for adults using the SIE technique. METHODS Aortic diameters obtained according to the two guideline recommendations at the aortic annuls, sinuses of Valsalva, sinotubular junction, and ascending aorta in 1,148 healthy adult volunteers were compared. Bland-Altman analysis, paired t tests, and intraclass correlation coefficients were evaluated at each segment. SIE values are reported as normative data, according to age, gender, and body surface area. RESULTS The diastolic leading edge-to-leading edge convention yielded smaller diameters (compared with SIE) at the aortic annulus and ascending aorta and larger diameters at the sinus of Valsalva and sinotubular junction (P < .001 for all). There was excellent correlation between these techniques, with intraclass correlation coefficients of 0.88 to 0.96. Interobserver variability was minimal and similar for both techniques. Using the SIE technique, diameters were larger for men and increased with age and larger body surface area. CONCLUSIONS Although there was a statistically significant difference in aortic diameter measures between the two conventions used, this difference was very small and correlations were excellent, suggesting that the difference has no clinical significance. The authors recommend that a standard convention be adopted within the American Society of Echocardiography and across all professional cardiovascular imaging societies for consistency and improved communication.
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Sridhar GS, Sadiq MA, Ahmad WAW, Supuramaniam C, Watson T, Abidin IZ, Chee KH. Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction and Supracristal Ventricular Septal Defect: A Rare Case. Tex Heart Inst J 2015; 42:462-4. [PMID: 26504442 DOI: 10.14503/thij-14-4483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Unruptured right sinus of Valsalva aneurysm that causes severe obstruction of the right ventricular outflow tract is extremely rare. We describe the case of a 47-year-old woman who presented with exertional dyspnea. Upon investigation, we discovered an unruptured right sinus of Valsalva aneurysm with associated right ventricular outflow tract obstruction and a supracristal ventricular septal defect. To our knowledge, only 2 such cases have previously been reported in the medical literature. Although treatment of unruptured sinus of Valsalva aneurysm remains debatable, surgery should be considered for extremely large aneurysms or for progressive enlargement of the aneurysm on serial evaluation. Surgery was undertaken in our patient because there was clear evidence of right ventricular outflow tract obstruction, right-sided heart dilation, and associated exertional dyspnea.
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