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Iqbal R, Alom S, BinSaeid J, Harky A. Loeys-Dietz syndrome pathology and aspects of cardiovascular management: A systematic review. Vascular 2020; 29:3-14. [PMID: 32559129 DOI: 10.1177/1708538120934582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Loeys-Dietz syndrome is an autosomal dominant genetic disorder which is associated with significant and often crucial vascular manifestations. This review is aimed to examine current evidence on pathophysiology and management of Loeys-Dietz syndrome in current era. A comprehensive electronic search was done to identify the articles that discussed all the aspects of Loeys-Dietz syndrome, combined key words and Medical Subject Headings (MeSH) terms were used. Relevant articles have been summarized in each relevant section. Loeys-Dietz syndrome is an autosomal dominant genetic disorder which has combined and multi-systemic manifestations. The increased breakdown of extracellular matrix predisposes an individual to developing aneurysms in the aortic tree which is undoubtedly the most significant complication of this disorder. Understanding the pathophysiology and natural history of Loeys-Dietz syndrome and regular surveillance is important to plan prophylactic interventions to prevent life-threatening aortic emergencies which can be fatal. Loeys-Dietz syndrome is an aggressive genetic condition that predisposes an individual to the development of life-threatening aortic aneurysms. Our understanding of Loeys-Dietz syndrome remains ever-changing and it is likely that the knowledge regarding its diagnosis and treatment will become more clearly defined in the coming years with deeper genetic studies.
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Affiliation(s)
| | - Samiha Alom
- School of Public Health, Imperial College London, London, UK
| | - Jalal BinSaeid
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Estrera AL, Sandhu HK, Afifi RO, Nguyen TC, Charlton-Ouw KM, Azizzadeh A, Miller CC, Safi HJ. Early and Late Outcomes After Complete Aortic Replacement. Ann Thorac Surg 2015; 100:528-34. [DOI: 10.1016/j.athoracsur.2015.02.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/16/2015] [Accepted: 02/19/2015] [Indexed: 11/25/2022]
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Afifi RO, Dhillon BS, Sandhu HK, Charlton-Ouw KM, Estrera AL, Azizzadeh A. Vertebral Artery Aneurysm Mimicking as Left Subclavian Artery Aneurysm in a Patient with Transforming Growth Factor Beta Receptor II Mutation. Ann Vasc Surg 2015; 29:1455.e7-1455.e11. [PMID: 26169464 DOI: 10.1016/j.avsg.2015.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
We report successful endovascular repair of a left vertebral artery aneurysm in a patient with transforming growth factor beta receptor II mutation. The patient was initially diagnosed with a left subclavian artery aneurysm on computed tomography angiography. The patient consented to publication of this report.
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Affiliation(s)
- Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX
| | - Baltej Singh Dhillon
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX
| | - Kristofer M Charlton-Ouw
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart & Vascular Institute, Texas Medical Center, Houston, TX
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart & Vascular Institute, Texas Medical Center, Houston, TX
| | - Ali Azizzadeh
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX; Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Heart & Vascular Institute, Texas Medical Center, Houston, TX.
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Williams JA, Hanna JM, Shah AA, Andersen ND, McDonald MT, Jiang YH, Wechsler SB, Zomorodi A, McCann RL, Hughes GC. Adult surgical experience with Loeys-Dietz syndrome. Ann Thorac Surg 2015; 99:1275-81. [PMID: 25678502 DOI: 10.1016/j.athoracsur.2014.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 11/02/2014] [Accepted: 11/17/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Loeys-Dietz syndrome (LDS) results from mutations in receptors for the cytokine transforming growth factor-β leading to aggressive aortic pathology sometimes accompanied by specific phenotypic features including bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity. We reviewed our adult surgical experience with LDS in order to validate current recommendations regarding management of this newly described disease. METHODS All adult (≥ 18 years old) patients with LDS undergoing surgical treatment at a single referral institution from September 1999 to May 2013 were retrospectively reviewed. RESULTS Eleven adult LDS patients were identified by clinical criteria and genotyping. Seven (64%) experienced acute type A dissection at some point in their lives. All eventually required aortic root replacement, and 73% required multiple vascular surgical interventions. Over a mean follow-up of 65 ± 49 months, 2.8 cardiovascular procedures per patient were performed. In patients with type A dissection, a mean of 3.4 operations were performed versus 1.8 operations for patients without dissection. Total aortic replacement was required in 5 patients (45%) and 2 (18%) required neurosurgical intervention for cerebrovascular pathology. There was 1 late death from infectious complications, and no deaths from vascular catastrophe. CONCLUSIONS These results confirm the aggressive nature of LDS aortic pathology. However, the improved survival compared with earlier LDS reports suggest that aggressive treatment strategies may alter outcomes and improve the natural history of this syndrome.
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Affiliation(s)
- Jason A Williams
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer M Hanna
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Asad A Shah
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nicholas D Andersen
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Marie T McDonald
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Yong-Hui Jiang
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Stephanie Burns Wechsler
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina; Department of Pediatrics, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Ali Zomorodi
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Richard L McCann
- Division of Vascular Surgery, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
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Nakajima T, Tachibana K, Miyaki Y, Takagi N, Morisaki T, Higami T. Acute dilatation of the ascending aorta and aortic valve regurgitation in Loeys-Dietz syndrome. Ann Thorac Surg 2014; 97:2188-90. [PMID: 24882305 DOI: 10.1016/j.athoracsur.2013.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/21/2013] [Accepted: 08/08/2013] [Indexed: 11/28/2022]
Abstract
Loeys-Dietz syndrome (LDS) is a recently recognized connective tissue disorder caused by mutations of the transforming growth factor (TGF)-β receptors. It is an autosomal dominant syndrome characterized by the triad of arterial tortuosity and aneurysms, hypertelorism, and bifid uvula or cleft palate. We treated an 18-year-old woman with a 100-mm-diameter aortic root aneurysm and severe aortic valve regurgitation. She underwent urgent aortic root replacement and bioprosthetic valve implantation. LDS was diagnosed by postoperative genetic screening results. Histopathologic examination of the aortic wall showed diffuse degeneration and elastin fragmentation in the media.
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Affiliation(s)
- Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kazutoshi Tachibana
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yasuko Miyaki
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuyuki Takagi
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takayuki Morisaki
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Tetsuya Higami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Casey K, Zayed M, Greenberg JI, Dalman RL, Lee JT. Endovascular repair of bilateral iliac artery aneurysms in a patient with Loeys-Dietz syndrome. Ann Vasc Surg 2011; 26:107.e5-10. [PMID: 21835579 DOI: 10.1016/j.avsg.2011.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 06/07/2011] [Accepted: 06/13/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Loeys-Dietz syndrome (LDS) is a rare congenital connective tissue disorder (CTD) caused by mutations in the gene encoding for transforming growth factor-β receptors I and II. This recently described syndrome is characterized by aortic aneurysms and dissections, arterial tortuosity, and spontaneous organ perforation. The technical feasibility of endovascular interventions, particularly endovascular aneurysm repair (EVAR), in CTDs is relatively unknown. METHODS AND RESULTS A 38-year-old man presented with asymptomatic bilateral common iliac artery aneurysms measuring 5.3 cm on the right and 4.3 cm on the left. The patient had an extensive surgical and medical history, including a recently repaired Stanford type-A aortic dissection, total colectomy with end ileostomy for a colonic perforation, splenectomy for rupture, and cirrhosis secondary to chronic hepatitis C. The patient's CTD, multiple abdominal surgeries performed in the past, and ileostomy made him a poor candidate for open repair. We elected to offer him a complex endovascular repair and hoped to preserve his pelvic circulation by using "double-barrel" configuration of stent-grafts in the right iliac artery system. Successful deployment of the devices and repair of femoral access allowed routine discharge on postoperative day 2. At 6-month follow-up, the patient's pelvic circulation has been maintained, the aneurysms are excluded without endoleak, and sac regression has been shown. CONCLUSION LDS is a rare connective tissue disorder characterized by vascular aneurysms and arterial tortuosity. When vascular reconstruction is necessary, open techniques are often preferred given the lack of data on endovascular procedures. In the present case, we report the first successful abdominal EVAR in a high-risk patient with LDS, providing excellent short-term results.
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Affiliation(s)
- Kevin Casey
- Division of Vascular and Endovascular Surgery, Stanford University Medical Center, Stanford, CA 94305, USA
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