1
|
Bulut HI, Arjomandi Rad A, Syrengela AA, Ttofi I, Djordjevic J, Kaur R, Keiralla A, Krasopoulos G. A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines. J Cardiovasc Dev Dis 2023; 10:398. [PMID: 37754827 PMCID: PMC10531880 DOI: 10.3390/jcdd10090398] [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: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE bicuspid aortic valve (BAV) stands as the most prevalent congenital heart condition intricately linked to aortic pathologies encompassing aortic regurgitation (AR), aortic stenosis, aortic root dilation, and aortic dissection. The aetiology of BAV is notably intricate, involving a spectrum of genes and polymorphisms. Moreover, BAV lays the groundwork for an array of structural heart and aortic disorders, presenting varying degrees of severity. Establishing a tailored clinical approach amid this diverse range of BAV-related conditions is of utmost significance. In this comprehensive review, we delve into the epidemiology, aetiology, associated ailments, and clinical management of BAV, encompassing imaging to aortic surgery. Our exploration is guided by the perspectives of the aortic team, spanning six distinct guidelines. METHODS We conducted an exhaustive search across databases like PubMed, Ovid, Scopus, and Embase to extract relevant studies. Our review incorporates 84 references and integrates insights from six different guidelines to create a comprehensive clinical management section. RESULTS BAV presents complexities in its aetiology, with specific polymorphisms and gene disorders observed in groups with elevated BAV prevalence, contributing to increased susceptibility to other cardiovascular conditions. The altered hemodynamics inherent to BAV instigate adverse remodelling of the aorta and heart, thus fostering the development of epigenetically linked aortic and heart diseases. Employing TTE screening for first-degree relatives of BAV patients might be beneficial for disease tracking and enhancing clinical outcomes. While SAVR is the primary recommendation for indicated AVR in BAV, TAVR might be an option for certain patients endorsed by adept aortic teams. In addition, proficient teams can perform aortic valve repair for AR cases. Aortic surgery necessitates personalized evaluation, accounting for genetic makeup and risk factors. While the standard aortic replacement threshold stands at 55 mm, it may be tailored to 50 mm or even 45 mm based on patient-specific considerations. CONCLUSION This review reiterates the significance of considering the multifactorial nature of BAV as well as the need for further research to be carried out in the field.
Collapse
Affiliation(s)
- Halil Ibrahim Bulut
- Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
| | | | | | - Iakovos Ttofi
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Jasmina Djordjevic
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Ramanjit Kaur
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Amar Keiralla
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| |
Collapse
|
2
|
Odelin G, Faucherre A, Marchese D, Pinard A, Jaouadi H, Le Scouarnec S, Chiarelli R, Achouri Y, Faure E, Herbane M, Théron A, Avierinos JF, Jopling C, Collod-Béroud G, Rezsohazy R, Zaffran S. Variations in the poly-histidine repeat motif of HOXA1 contribute to bicuspid aortic valve in mouse and zebrafish. Nat Commun 2023; 14:1543. [PMID: 36941270 PMCID: PMC10027860 DOI: 10.1038/s41467-023-37110-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
Bicuspid aortic valve (BAV), the most common cardiovascular malformation occurs in 0.5-1.2% of the population. Although highly heritable, few causal mutations have been identified in BAV patients. Here, we report the targeted sequencing of HOXA1 in a cohort of BAV patients and the identification of rare indel variants in the homopolymeric histidine tract of HOXA1. In vitro analysis shows that disruption of this motif leads to a significant reduction in protein half-life and defective transcriptional activity of HOXA1. In zebrafish, targeting hoxa1a ortholog results in aortic valve defects. In vivo assays indicates that these variants behave as dominant negatives leading abnormal valve development. In mice, deletion of Hoxa1 leads to BAV with a very small, rudimentary non-coronary leaflet. We also show that 17% of homozygous Hoxa1-1His knock-in mice present similar phenotype. Genetic lineage tracing in Hoxa1-/- mutant mice reveals an abnormal reduction of neural crest-derived cells in the valve leaflet, which is caused by a failure of early migration of these cells.
Collapse
Affiliation(s)
- Gaëlle Odelin
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
| | - Adèle Faucherre
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Damien Marchese
- Animal Molecular and Cellular Biology group, Louvain Institute of Biomolecular Science and Technology, Université catholique de Louvain, 5 (L7.07.10) place Croix du Sud, 1348, Louvain-la-Neuve, Belgium
| | - Amélie Pinard
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
| | - Hager Jaouadi
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
| | | | | | - Raphaël Chiarelli
- Animal Molecular and Cellular Biology group, Louvain Institute of Biomolecular Science and Technology, Université catholique de Louvain, 5 (L7.07.10) place Croix du Sud, 1348, Louvain-la-Neuve, Belgium
| | - Younes Achouri
- Transgenesis Platform, de Duve Institute, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Emilie Faure
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
| | - Marine Herbane
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
| | - Alexis Théron
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
- Service de Chirurgie Cardiaque, AP-HM, Hôpital de la Timone, 13005, Marseille, France
| | - Jean-François Avierinos
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France
- Service de Cardiologie, AP-HM, Hôpital de la Timone, 13005, Marseille, France
| | - Chris Jopling
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | | | - René Rezsohazy
- Animal Molecular and Cellular Biology group, Louvain Institute of Biomolecular Science and Technology, Université catholique de Louvain, 5 (L7.07.10) place Croix du Sud, 1348, Louvain-la-Neuve, Belgium
| | - Stéphane Zaffran
- Aix Marseille Univ, INSERM, MMG, U1251, 13005, Marseille, France.
| |
Collapse
|
3
|
Fatehi Hassanabad A, King MA, Di Martino E, Fedak PWM, Garcia J. Clinical implications of the biomechanics of bicuspid aortic valve and bicuspid aortopathy. Front Cardiovasc Med 2022; 9:922353. [PMID: 36035900 PMCID: PMC9411999 DOI: 10.3389/fcvm.2022.922353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022] Open
Abstract
Bicuspid aortic valve (BAV), which affects up to 2% of the general population, results from the abnormal fusion of the cusps of the aortic valve. Patients with BAV are at a higher risk for developing aortic dilatation, a condition known as bicuspid aortopathy, which is associated with potentially life-threatening sequelae such as aortic dissection and aortic rupture. Although BAV biomechanics have been shown to contribute to aortopathy, their precise impact is yet to be delineated. Herein, we present the latest literature related to BAV biomechanics. We present the most recent definitions and classifications for BAV. We also summarize the current evidence pertaining to the mechanisms that drive bicuspid aortopathy. We highlight how aberrant flow patterns can contribute to the development of aortic dilatation. Finally, we discuss the role cardiac magnetic resonance imaging can have in assessing and managing patient with BAV and bicuspid aortopathy.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Melissa A. King
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Elena Di Martino
- Department of Civil Engineering, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Centre for Bioengineering Research and Education, University of Calgary, Calgary, AB, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- *Correspondence: Julio Garcia
| |
Collapse
|
4
|
Point on the Aortic Bicuspid Valve. Life (Basel) 2022; 12:life12040518. [PMID: 35455009 PMCID: PMC9029119 DOI: 10.3390/life12040518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background—Bicuspid aortic valve (BAV) disease is the most prevalent congenital heart disease in the world. Knowledge about its subtypes origin, development, and evolution is poor despite the frequency and the potential gravity of this condition. Its prognosis mostly depends on the risk of aortic aneurysm development with an increased risk of aortic dissection. Aims—This review aims to describe this complex pathology in way to improve the bicuspid patients’ management. Study design—We reviewed the literature with MEDLINE and EMBASE databases using MeSH terms such as “bicuspid aortic valve”, “ascending aorta”, and “bicuspid classification”. Results—There are various classifications. They depend on the criteria chosen by the authors to differentiate subtypes. Those criteria can be the number and position of the raphes, the cusps, the commissures, or their arrangements regarding coronary ostia. Sievers’ classification is the reference. The phenotypic description of embryology revealed that all subtypes of BAV are the results of different embryological pathogenesis, and therefore, should be considered as distinct conditions. Their common development towards aortic dilatation is explained by the aortic media’s pathological histology with cystic medial necrosis. At the opposite, BAV seems to display a profound genetic heterogeneity with both sporadic and familial forms. BAV can be even isolated or combined with other congenital malformations. Conclusions—All those characteristics make this pathology a highly complex condition that needs further genetic, embryological, and hemodynamic explorations to complete its well described anatomy.
Collapse
|
5
|
Vedel C, Rode L, Bundgaard H, Iversen K, Jørgensen FS, Petersen OB, Sillesen AS, Sundberg K, Vejlstrup N, Zingenberg H, Tabor A, Ekelund CK. Prenatal cardiac biometry and flow assessment in fetuses with bicuspid aortic valve at 20 weeks' gestation: multicenter cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:846-852. [PMID: 33998082 DOI: 10.1002/uog.23670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate prenatal changes in cardiac biometric and flow parameters in fetuses with bicuspid aortic valve (BAV) diagnosed neonatally compared with controls with normal cardiac anatomy. METHODS This analysis was conducted as part of the Copenhagen Baby Heart Study, a multicenter cohort study of 25 556 neonates that underwent second-trimester anomaly scan at 18 + 0 to 22 + 6 weeks' gestation and neonatal echocardiography within 4 weeks after birth, in Copenhagen University Hospital Herlev, Hvidovre Hospital and Rigshospitalet in greater Copenhagen, between April 2016 and October 2018. From February 2017 (Rigshospitalet) and September 2017 (Herlev and Hvidovre hospitals), the protocol for second-trimester screening of the heart was extended to include evaluation of the four-chamber view, with assessment of flow across the atrioventricular valves, sagittal view of the aortic arch and midumbilical artery and ductus venosus pulsatility indices. All images were evaluated by two investigators, and cardiac biometric and flow parameters were measured and compared between cases with BAV and controls. All cases with neonatal BAV were assessed by a specialist. Maternal characteristics and first- and second-trimester biomarkers were also compared between the two groups. RESULTS Fifty-five infants with BAV and 8316 controls with normal cardiac anatomy were identified during the study period and assessed using the extended prenatal cardiac imaging protocol. There were three times as many mothers who smoked before pregnancy in the group with BAV as in the control group (9.1% vs 2.7%; P = 0.003). All other baseline characteristics were similar between the two groups. Fetuses with BAV, compared with controls, had a significantly larger diameter of the aorta at the level of the aortic valve (3.1 mm vs 3.0 mm (mean difference, 0.12 mm (95% CI, 0.03-0.21 mm))) and the pulmonary artery at the level of the pulmonary valve (4.1 mm vs 3.9 mm (mean difference, 0.15 mm (95% CI, 0.03-0.28 mm))). Following conversion of the diameter measurements of the aorta and pulmonary artery to Z-scores and Bonferroni correction, the differences between the two groups were no longer statistically significant. Pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) was significantly lower in the BAV group than in the control group (0.85 vs 1.03; P = 0.04). CONCLUSIONS Our findings suggest that fetuses with BAV may have a larger aortic diameter at the level of the aortic valve, measured in the left-ventricular-outflow-tract view, and a larger pulmonary artery diameter at the level of the pulmonary valve, measured in the three-vessel view, at 20 weeks' gestation. Moreover, we found an association of maternal smoking and low PAPP-A MoM with BAV. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- C Vedel
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - L Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - H Bundgaard
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - K Iversen
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - F S Jørgensen
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - O B Petersen
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A-S Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - K Sundberg
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - N Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Zingenberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - C K Ekelund
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| |
Collapse
|
6
|
Yan W, Li J, Wang W, Wei L, Wang S. A Fluid-Structure Interaction Study of Different Bicuspid Aortic Valve Phenotypes Throughout the Cardiac Cycle. Front Physiol 2021; 12:716015. [PMID: 34381379 PMCID: PMC8350765 DOI: 10.3389/fphys.2021.716015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
The bicuspid aortic valve (BAV) is a congenital malformation of the aortic valve with a variety of structural features. The current research on BAV mainly focuses on the systolic phase, while ignoring the diastolic hemodynamic characteristics and valve mechanics. The purpose of this study is to compare the differences in hemodynamics and mechanical properties of BAV with different phenotypes throughout the cardiac cycle by means of numerical simulation. Based on physiological anatomy, we established an idealized tricuspid aortic valve (TAV) model and six phenotypes of BAV models (including Type 0 a-p, Type 0 lat, Type 1 L-R, Type 1 N-L, Type 1 R-N, and Type 2), and simulated the dynamic changes of the aortic valve during the cardiac cycle using the fluid-structure interaction method. The morphology of the leaflets, hemodynamic parameters, flow patterns, and strain were analyzed. Compared with TAV, the cardiac output and effective orifice area of different BAV phenotypes decreased certain degree, along with the peak velocity and mean pressure difference increased both. Among all BAV models, Type 2 exhibited the worst hemodynamic performance. During the systole, obvious asymmetric flow field was observed in BAV aorta, which was related to the orientation of BAV. Higher strain was generated in diastole for BAV models. The findings of this study suggests specific differences in the hemodynamic characteristics and valve mechanics of different BAV phenotypes, including different severity of stenosis, flow patterns, and leaflet strain, which may be critical for prediction of other subsequent aortic diseases and differential treatment strategy for certain BAV phenotype.
Collapse
Affiliation(s)
- Wentao Yan
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Jianming Li
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Wenshuo Wang
- Department of Vascular Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lai Wei
- Department of Vascular Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Disha K, Schulz S, Mierzwa M, Owais T, Girdauskas E, Kuntze T. Double-Hit Mutations in Bicuspid Aortic Valve and Blunt Traumatic Acute Aortic Dissection. Ann Thorac Surg 2020; 111:e5-e6. [PMID: 32544455 DOI: 10.1016/j.athoracsur.2020.04.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
We report on a young patient with a bicuspid aortic valve operated on for type A acute aortic dissection because of a blunt thoracic trauma. Aortic root replacement and ascending aortic and total arch repair together with the postoperative course were uneventful. Multigenerational genetic analyses revealed mutations in the NOTCH1 and ACTA2 genes in the patient and his father. The screening of his parents and children revealed no bicuspid aortic valve or aortic root dilation. This exceptionally rare case of double-hit mutations and the presence of blunt trauma reveals the complex etiology of aortic dissection in patients with a bicuspid aortic valve.
Collapse
Affiliation(s)
- Kushtrim Disha
- Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
| | - Solveig Schulz
- Institute of Human Genetics and Anthropology, Jena University Hospital, Jena, Germany
| | - Marco Mierzwa
- Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany
| | - Tamer Owais
- Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Thomas Kuntze
- Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany
| |
Collapse
|
8
|
Qin T, Caballero A, Mao W, Barrett B, Kamioka N, Lerakis S, Sun W. The role of stress concentration in calcified bicuspid aortic valve. J R Soc Interface 2020; 17:20190893. [PMID: 32517630 DOI: 10.1098/rsif.2019.0893] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is the most common valvular heart disease in the aging population, and is now believed to be a slow, progressive, yet actively regulated process. The disease progression can be divided into two phases: initiation phase associated with lipid deposition and inflammation response, and the later propagation phase with active calcification growth. It has been hypothesized that elevated mechanical stress plays a major role in both phases of disease progression. In order to identify a direct link between leaflet stress and calcification development, we performed patient-specific finite-element (FE) analyses of six bicuspid aortic valves (BAV), where the leaflets, raphe and calcifications were all considered. The results showed that during the initiation phase, calcium buildup is likely to occur along the leaflet-root attachment curve (ATC), and the commissures, which are subject to the most drastic changes in stress during the cardiac cycle. During the propagation phase, the presence of calcification would lead to local stress concentration along its boundary, hence further calcification growth. Three patterns of calcification formation were identified on BAV leaflets: 'radial', which extended radially from ATC into the leaflet belly region; 'commissure to commissure', which extended circumferentially along the coaptation; and 'raphe', which located in the vicinity of the raphe. Furthermore, we found a strong correlation between regions with a high risk of calcium buildup and regions with elevated mechanical stress. The high-risk regions predicted at diastole on the non-calcified leaflet from FE models agreed reasonably well with the in vivo calcification locations, which indicates that patient-specific FE modelling could help us to evaluate the potential risk of calcification formation in the early stage of CAVD.
Collapse
Affiliation(s)
- Tongran Qin
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Brian Barrett
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | | | - Stamatios Lerakis
- School of Medicine, Emory University, Atlanta, GA, USA.,Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| |
Collapse
|
9
|
Liu B, Granville DJ, Golledge J, Kassiri Z. Pathogenic mechanisms and the potential of drug therapies for aortic aneurysm. Am J Physiol Heart Circ Physiol 2020; 318:H652-H670. [PMID: 32083977 PMCID: PMC7099451 DOI: 10.1152/ajpheart.00621.2019] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
Abstract
Aortic aneurysm is a permanent focal dilation of the aorta. It is usually an asymptomatic disease but can lead to sudden death due to aortic rupture. Aortic aneurysm-related mortalities are estimated at ∼200,000 deaths per year worldwide. Because no pharmacological treatment has been found to be effective so far, surgical repair remains the only treatment for aortic aneurysm. Aortic aneurysm results from changes in the aortic wall structure due to loss of smooth muscle cells and degradation of the extracellular matrix and can form in different regions of the aorta. Research over the past decade has identified novel contributors to aneurysm formation and progression. The present review provides an overview of cellular and noncellular factors as well as enzymes that process extracellular matrix and regulate cellular functions (e.g., matrix metalloproteinases, granzymes, and cathepsins) in the context of aneurysm pathogenesis. An update of clinical trials focusing on therapeutic strategies to slow abdominal aortic aneurysm growth and efforts underway to develop effective pharmacological treatments is also provided.
Collapse
Affiliation(s)
- Bo Liu
- University of Wisconsin, Madison, Department of Surgery, Madison Wisconsin
| | - David J Granville
- International Collaboration on Repair Discoveries Centre and University of British Columbia Centre for Heart Lung Innovation, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Golledge
- The Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Department of Vascular and Endovascular Surgery, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Zamaneh Kassiri
- University of Alberta, Department of Physiology, Cardiovascular Research Center, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| |
Collapse
|
10
|
Maleki S, Poujade FA, Bergman O, Gådin JR, Simon N, Lång K, Franco-Cereceda A, Body SC, Björck HM, Eriksson P. Endothelial/Epithelial Mesenchymal Transition in Ascending Aortas of Patients With Bicuspid Aortic Valve. Front Cardiovasc Med 2019; 6:182. [PMID: 31921896 PMCID: PMC6928128 DOI: 10.3389/fcvm.2019.00182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Thoracic aortic aneurysm (TAA) is the progressive enlargement of the aorta due to destructive changes in the connective tissue of the aortic wall. Aneurysm development is silent and often first manifested by the drastic events of aortic dissection or rupture. As yet, therapeutic agents that halt or reverse the process of aortic wall deterioration are absent, and the only available therapeutic recommendation is elective prophylactic surgical intervention. Being born with a bicuspid instead of the normal tricuspid aortic valve (TAV) is a major risk factor for developing aneurysm in the ascending aorta later in life. Although the pathophysiology of the increased aneurysm susceptibility is not known, recent studies are suggestive of a transformation of aortic endothelium into a more mesenchymal state i.e., an endothelial-to-mesenchymal transition in these individuals. This process involves the loss of endothelial cell features, resulting in junction instability and enhanced vascular permeability of the ascending aorta that may lay the ground for increased aneurysm susceptibility. This finding differentiates and further emphasizes the specific characteristics of aneurysm development in individuals with a bicuspid aortic valve (BAV). This review discusses the possibility of a developmental fate shared between the aortic endothelium and aortic valves. It further speculates about the impact of aortic endothelium phenotypic shift on aneurysm development in individuals with a BAV and revisits previous studies in the light of the new findings.
Collapse
Affiliation(s)
- Shohreh Maleki
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Flore-Anne Poujade
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Otto Bergman
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Jesper R Gådin
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Nancy Simon
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Karin Lång
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Simon C Body
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Hanna M Björck
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Per Eriksson
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| |
Collapse
|
11
|
Odelin G, Faure E, Maurel-Zaffran C, Zaffran S. Krox20 Regulates Endothelial Nitric Oxide Signaling in Aortic Valve Development and Disease. J Cardiovasc Dev Dis 2019; 6:jcdd6040039. [PMID: 31684048 PMCID: PMC6955692 DOI: 10.3390/jcdd6040039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
Among the aortic valve diseases, the bicuspid aortic valve (BAV) occurs when the aortic valve has two leaflets (cusps), rather than three, and represents the most common form of congenital cardiac malformation, affecting 1–2% of the population. Despite recent advances, the etiology of BAV is poorly understood. We have recently shown that Krox20 is expressed in endothelial and cardiac neural crest derivatives that normally contribute to aortic valve development and that lack of Krox20 in these cells leads to aortic valve defects including partially penetrant BAV formation. Dysregulated expression of endothelial nitric oxide synthase (Nos3) is associated with BAV. To investigate the relationship between Krox20 and Nos3 during aortic valve development, we performed inter-genetic cross. While single heterozygous mice had normal valve formation, the compound Krox20+/−;Nos3+/− mice had BAV malformations displaying an in vivo genetic interaction between these genes for normal valve morphogenesis. Moreover, in vivo and in vitro experiments demonstrate that Krox20 directly binds to Nos3 proximal promoter to activate its expression. Our data suggests that Krox20 is a regulator of nitric oxide in endothelial-derived cells in the development of the aortic valve and concludes on the interaction of Krox20 and Nos3 in BAV formation.
Collapse
Affiliation(s)
- Gaëlle Odelin
- Aix Marseille University, INSERM, Marseille Medical Genetics, U1251, 13005 Marseille, France.
| | - Emilie Faure
- Aix Marseille University, INSERM, Marseille Medical Genetics, U1251, 13005 Marseille, France.
| | | | - Stéphane Zaffran
- Aix Marseille University, INSERM, Marseille Medical Genetics, U1251, 13005 Marseille, France.
| |
Collapse
|
12
|
Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2019; 156:e41-e74. [PMID: 30011777 DOI: 10.1016/j.jtcvs.2018.02.115] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 01/17/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Bicuspid aortic valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of bicuspid aortic valve aortopathy and to guide the daily management of these complex patients.
Collapse
Affiliation(s)
- Michael A Borger
- Leipzig Heart Center, Cardiac Surgery, University of Leipzig, Leipzig, Germany.
| | - Paul W M Fedak
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, Calif
| | - Samuel C Siu
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hope
- San Francisco (UCSF) Department of Radiology & Biomedical Imaging, University of California, San Francisco, Calif
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Tex
| | - Marc R Moon
- Section of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Michael Markl
- Departments of Radiology and Biomedical Engineering, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn
| |
Collapse
|
13
|
The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Executive summary. J Thorac Cardiovasc Surg 2019; 156:473-480. [PMID: 30011756 DOI: 10.1016/j.jtcvs.2017.10.161] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 12/20/2022]
Abstract
Bicuspid aortic valve disease is a common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current document is an executive summary of "The American Association for Thoracic Surgery Guidelines on Bicuspid Aortic Valve-Related Aortopathy." All major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research are contained within these guidelines. The current executive summary serves as a condensed version of the guidelines to provide clinicians with a current and comprehensive review of bicuspid aortic valve aortopathy and to guide the daily management of these complex patients.
Collapse
|
14
|
Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol 2019; 133:76-85. [PMID: 31152748 DOI: 10.1016/j.yjmcc.2019.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 01/30/2023]
Abstract
Herein we summarize the current knowledge on the bicuspid aortic valve (BAV)-associated aortopathy regarding clinical presentation and disease sub-classification, genetic background, hemodynamics, histopathology, cells and signaling, animal models, and biomarkers. Despite enormous efforts in research in all of the above areas, important issues remain unknown: (i) what is the ontogenetic basis of BAV development? (ii) how can we explain the diversity of BAV and associated aortopathy phenotypes? (iii) what are the signaling processes in aortopathy pathogenesis and how can we interfere with these processes? Despite undoubtedly great progress that has been made in the understanding of BAV-associated aortopathy, so far researchers have put together a heap of Lego bricks, but at present it is unclear if the bricks are compatible, how they fit together, and which parts are missing to build the true model of the BAV aorta. A joint approach is needed to accelerate research progress.
Collapse
Affiliation(s)
- Barbara Messner
- Cardiac Surgery Research Laboratory, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - David Bernhard
- Center for Medical Research, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
| |
Collapse
|
15
|
Aquila I, Frati G, Sciarretta S, Dellegrottaglie S, Torella D, Torella M. New imaging techniques project the cellular and molecular alterations underlying bicuspid aortic valve development. J Mol Cell Cardiol 2019; 129:197-207. [PMID: 30826295 DOI: 10.1016/j.yjmcc.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/29/2022]
Abstract
Bicuspid aortic valve (BAV) disease is the most common congenital cardiac malformation associated with an increased lifetime risk and a high rate of surgically-relevant valve deterioration and aortic dilatation. Genomic data revealed that different genes are associated with BAV. A dominant genetic factor for the recent past was the basis to the recommendation for a more extensive aortic intervention. However very recent evidence that hemodynamic stressors and alterations of wall shear stress play an important role independent from the genetic trait led to more conservative treatment recommendations. Therefore, there is a current need to improve the ability to risk stratify BAV patients in order to obtain an early detection of valvulopathy and aortopathy while also to predict valve dysfunction and/or aortic disease development. Imaging studies based on new cutting-edge technologies, such us 4-dimensional (4D) flow magnetic resonance imaging (MRI), two-dimensional (2D) or three-dimensional (3D) speckle-tracking imaging (STI) and computation fluid dynamics, combined with studies demonstrating new gene mutations, specific signal pathways alterations, hemodynamic influences, circulating biomarkers modifications, endothelial progenitor cell impairment and immune/inflammatory response, all detected BAV valvulopathy progression and aortic wall abnormality. Overall, the main purpose of this review article is to merge the evidences of imaging and basic science studies in a coherent hypothesis that underlies and thus projects the development of both BAV during embryogenesis and BAV-associated aortopathy and its complications in the adult life, with the final goal to identifying aneurysm formation/rupture susceptibility to improve diagnosis and management of patients with BAV-related aortopathy.
Collapse
Affiliation(s)
- Iolanda Aquila
- Molecular and Cellular Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, IS, Italy.
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, Acerra, Naples 80011, Italy; The Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniele Torella
- Molecular and Cellular Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy.
| | - Michele Torella
- Department of Cardiothoracic Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| |
Collapse
|
16
|
Sticchi E, De Cario R, Magi A, Giglio S, Provenzano A, Nistri S, Pepe G, Giusti B. Bicuspid Aortic Valve: Role of Multiple Gene Variants in Influencing the Clinical Phenotype. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8386123. [PMID: 30255099 PMCID: PMC6145047 DOI: 10.1155/2018/8386123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
Background. Bicuspid aortic valve (BAV) is a common congenital heart defect with increased prevalence of aortic dilatation and dissection. BAV has an autosomal dominant pattern of inheritance with reduced penetrance and variable expressivity. BAV has been described as an isolated trait or associated with other clinical manifestations in syndromic conditions. Identification of a syndromic condition in a BAV patient is clinically relevant in order to personalize indication to aortic surgery. We aimed to point out how genetic diagnosis by next-generation sequencing (NGS) can improve management of a patient with complex BAV clinical picture. Methods and Results. We describe a 45-year-old Caucasian male with BAV, thoracic aortic root and ascending aorta dilatation, and connective features evocative but inconclusive for clinical diagnosis of Marfan syndrome (MFS). Targeted (91 genes) NGS was used. Proband genetic variants were investigated in first-degree relatives. Proband carried 5 rare variants in 4 genes: FBN1(p.Asn542Ser and p.Lys2460Arg), NOTCH1(p.Val1739Met), LTBP1(p.Arg1330Gln), and TGFBR3(p.Arg423Trp). The two FBN1 variants were inherited in cis by the mother, showing systemic features evocative of MFS, but with a milder phenotype than that observed in the proband. Careful clinical observation along with the presence of the FBN1 variants allowed diagnosis of MFS in the proband and in his mother. NOTCH1 variant was found in mother and brother, not exhibiting BAV, thus not definitely supporting/excluding association with BAV. Interestingly, the proband, his brother and father, all showing root dilatation, and his sister, with upper range aortic root dimension, were carriers of a TGFBR3 variant. LTBP1 might also modulate the vascular phenotype. Conclusions. Our results underline the usefulness of NGS together with family evaluation in diagnosis of patients with monogenic traits and overlapping clinical manifestations due to contribution of the same genes and/or presence of comorbidities determined by different genes.
Collapse
Affiliation(s)
- Elena Sticchi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| | - Rosina De Cario
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
| | - Sabrina Giglio
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Italy
- Medical Genetic Unit, Meyer Children's University Hospital, Florence, Italy
| | - Aldesia Provenzano
- Department of Biomedical Experimental and Clinical Sciences 'Mario Serio', University of Florence, Italy
| | - Stefano Nistri
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
| | - Guglielmina Pepe
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Italy
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Florence, Italy
- Excellence Centre for Research, Transfer and High Education for the Development of De Novo Therapies (DENOTHE), University of Florence, Florence, Italy
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW The incidence of aortic dilation and acute complications (rupture and dissection) is higher in patients with a bicuspid aortic valve (BAV), the most frequent congenital heart defect.The present review focuses on the current knowledge in the genetics of BAV, emphasizing the clinical implications for early detection and personalized care. RECENT FINDINGS BAV is a highly heritable trait, but the genetic causes remain largely elusive. NOTCH1 is the only proven candidate gene to be associated with both familial and sporadic BAV. Other genes have been reported to be associated with BAV, but some of these associations may result from coexisting disease.The application of modern high-throughput technologies (next generation sequencing, genome-wide copy number and genome-wide methylation arrays) have begun to dissect the genetic heterogeneity underlying BAV as well as the diverse molecular pathways involved in the progression of BAV aortopathy. SUMMARY The clinical variability seen in BAV aortopathy, in terms of phenotype and natural/clinical history, suggests complex interactions between primary genetic defects, other modifier genes, epigenetic factors (DNA methylation or histone modifications, microRNA) and environmental factors (disturbed flow). Integrated, more comprehensive studies are needed for elucidating these connections to develop more individualized and accurate risk assessment methods.
Collapse
|
18
|
Abstract
A number of congenital defects and acquired disease processes affect the thoracic aorta, and traditionally, computed tomography (CT) has been the mainstay of imaging, especially in evaluation of the acute aorta. However, recent advances in magnetic resonance (MR) imaging such as electrocardiographically (ECG) triggered breath-hold sequences and ultrafast 3-dimensional MR angiography (MRA) are bringing MR imaging to the forefront of imaging of the thoracic aorta. By providing high-resolution morphological imaging and sophisticated vascular flow analysis for functional data, this modality can provide a comprehensive, reproducible evaluation of the thoracic aorta. In this review, we discuss the role of MR imaging in the evaluation of thoracic aorta pathology along with pertinent examples of aortic abnormalities.
Collapse
Affiliation(s)
- John P Lichtenberger
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Derek F Franco
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jason S Kim
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
19
|
Altered DNA methylation indicates an oscillatory flow mediated epithelial-to-mesenchymal transition signature in ascending aorta of patients with bicuspid aortic valve. Sci Rep 2018; 8:2777. [PMID: 29426841 PMCID: PMC5807320 DOI: 10.1038/s41598-018-20642-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/23/2018] [Indexed: 12/30/2022] Open
Abstract
Disturbed flow has been suggested to contribute to aneurysm susceptibility in bicuspid aortic valve (BAV) patients. Lately, flow has emerged as an important modulator of DNA methylation. Hear we combined global methylation analysis with in vitro studies of flow-sensitive methylation to identify biological processes associated with BAV-aortopathy and the potential contribution of flow. Biopsies from non-dilated and dilated ascending aortas were collected from BAV (n = 21) and tricuspid aortic valve (TAV) patients (n = 23). DNA methylation and gene expression was measured in aortic intima-media tissue samples, and in EA.hy926 and primary aortic endothelial cells (ECs) isolated from BAV and TAV exposed to oscillatory (±12 dynes/cm2) or laminar (12 dynes/cm2) flow. We show methylation changes related to epithelial-mesenchymal-transition (EMT) in the non-dilated BAV aorta, associated with oscillatory flow related to endocytosis. The results indicate that the flow-response in BAV ECs involves hypomethylation and increased expression of WNT/β-catenin genes, as opposed to an angiogenic profile in TAV ECs. The EMT-signature was exasperated in dilated BAV aortas. Aberrant EMT in BAV aortic walls could contribute to increased aneurysm susceptibility, and may be due to disturbed flow-exposure. Perturbations during the spatiotemporally related embryonic development of ascending aorta and semilunar valves can however not be excluded.
Collapse
|
20
|
van de Pol V, Kurakula K, DeRuiter MC, Goumans MJ. Thoracic Aortic Aneurysm Development in Patients with Bicuspid Aortic Valve: What Is the Role of Endothelial Cells? Front Physiol 2017; 8:938. [PMID: 29249976 PMCID: PMC5714935 DOI: 10.3389/fphys.2017.00938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/06/2017] [Indexed: 12/28/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most common type of congenital cardiac malformation. Patients with a BAV have a predisposition for the development of thoracic aortic aneurysm (TAA). This pathological aortic dilation may result in aortic rupture, which is fatal in most cases. The abnormal aortic morphology of TAAs results from a complex series of events that alter the cellular structure and extracellular matrix (ECM) composition of the aortic wall. Because the major degeneration is located in the media of the aorta, most studies aim to unravel impaired smooth muscle cell (SMC) function in BAV TAA. However, recent studies suggest that endothelial cells play a key role in both the initiation and progression of TAAs by influencing the medial layer. Aortic endothelial cells are activated in BAV mediated TAAs and have a substantial influence on ECM composition and SMC phenotype, by secreting several key growth factors and matrix modulating enzymes. In recent years there have been significant advances in the genetic and molecular understanding of endothelial cells in BAV associated TAAs. In this review, the involvement of the endothelial cells in BAV TAA pathogenesis is discussed. Endothelial cell functioning in vessel homeostasis, flow response and signaling will be highlighted to give an overview of the importance and the under investigated potential of endothelial cells in BAV-associated TAA.
Collapse
Affiliation(s)
- Vera van de Pol
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Kondababu Kurakula
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Marco C. DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
21
|
Martínez-Vargas J, Ventura J, Machuca Á, Muñoz-Muñoz F, Fernández MC, Soto-Navarrete MT, Durán AC, Fernández B. Cardiac, mandibular and thymic phenotypical association indicates that cranial neural crest underlies bicuspid aortic valve formation in hamsters. PLoS One 2017; 12:e0183556. [PMID: 28953926 PMCID: PMC5617148 DOI: 10.1371/journal.pone.0183556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/07/2017] [Indexed: 11/18/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most prevalent human congenital cardiac malformation. It may appear isolated, associated with other cardiovascular malformations, or forming part of syndromes. Cranial neural crest (NC) defects are supposed to be the cause of the spectrum of disorders associated with syndromic BAV. Experimental studies with an inbred hamster model of isolated BAV showed that alterations in the migration or differentiation of the cardiac NC cells in the embryonic cardiac outflow tract are most probably responsible for the development of this congenital valvular defect. We hypothesize that isolated BAV is not the result of local, but of early alterations in the behavior of the NC cells, thus also affecting other cranial NC-derived structures. Therefore, we tested whether morphological variation of the aortic valve is linked to phenotypic variation of the mandible and the thymus in the hamster model of isolated BAV, compared to a control strain. Our results show significant differences in the size and shape of the mandible as well as in the cellular composition of the thymus between the two strains, and in mandible shape regarding the morphology of the aortic valve. Given that both the mandible and the thymus are cranial NC derivatives, and that the cardiac NC belongs to the cephalic domain, we propose that the causal defect leading to isolated BAV during embryonic development is not restricted to local alterations of the cardiac NC cells in the cardiac outflow tract, but it is of pleiotropic or polytopic nature. Our results suggest that isolated BAV may be the forme fruste of a polytopic syndrome involving the cranial NC in the hamster model and in a proportion of affected patients.
Collapse
Affiliation(s)
- Jessica Martínez-Vargas
- Departament de Biologia Animal, Biologia Vegetal i Ecologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Jacint Ventura
- Departament de Biologia Animal, Biologia Vegetal i Ecologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- * E-mail:
| | - Ángela Machuca
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
| | - Francesc Muñoz-Muñoz
- Departament de Biologia Animal, Biologia Vegetal i Ecologia, Facultat de Biociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - María Carmen Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Ana Carmen Durán
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| |
Collapse
|
22
|
Giusti B, Sticchi E, De Cario R, Magi A, Nistri S, Pepe G. Genetic Bases of Bicuspid Aortic Valve: The Contribution of Traditional and High-Throughput Sequencing Approaches on Research and Diagnosis. Front Physiol 2017; 8:612. [PMID: 28883797 PMCID: PMC5573733 DOI: 10.3389/fphys.2017.00612] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/09/2017] [Indexed: 12/20/2022] Open
Abstract
Bicuspid aortic valve (BAV) is a common (0.5-2.0% of general population) congenital heart defect with increased prevalence of aortic dilatation and dissection. BAV has an autosomal dominant inheritance with reduced penetrance and variable expressivity. BAV has been described as an isolated trait or associated with syndromic conditions [e.g., Marfan Marfan syndrome or Loeys-Dietz syndrome (MFS, LDS)]. Identification of a syndromic condition in a BAV patient is clinically relevant to personalize aortic surgery indication. A 4-fold increase in BAV prevalence in a large cohort of unrelated MFS patients with respect to general population was reported, as well as in LDS patients (8-fold). It is also known that BAV is more frequent in patients with thoracic aortic aneurysm (TAA) related to mutations in ACTA2, FBN1, and TGFBR2 genes. Moreover, in 8 patients with BAV and thoracic aortic dilation, not fulfilling the clinical criteria for MFS, FBN1 mutations in 2/8 patients were identified suggesting that FBN1 or other genes involved in syndromic conditions correlated to aortopathy could be involved in BAV. Beyond loci associated to syndromic disorders, studies in humans and animal models evidenced/suggested the role of further genes in non-syndromic BAV. The transcriptional regulator NOTCH1 has been associated with the development and acceleration of calcium deposition. Genome wide marker-based linkage analysis demonstrated a linkage of BAV to loci on chromosomes 18, 5, and 13q. Recently, a role for GATA4/5 in aortic valve morphogenesis and endocardial cell differentiation has been reported. BAV has also been associated with a reduced UFD1L gene expression or involvement of a locus containing AXIN1/PDIA2. Much remains to be understood about the genetics of BAV. In the last years, high-throughput sequencing technologies, allowing the analysis of large number of genes or entire exomes or genomes, progressively became available. The latter issue together with the development of "BigData" analysis methods improving their interpretation and integration with clinical data represents a promising opportunity to increase the disease knowledge and diagnosis in monogenic and multifactorial complex traits. This review summarized the main knowledge on the BAV genetic bases, the role of genetic diagnosis in BAV patient managements and the crucial challenges for the comprehension of genetics of BAV in research and diagnosis.
Collapse
Affiliation(s)
- Betti Giusti
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of FlorenceFlorence, Italy.,Marfan Syndrome and Related Disorders Regional (Tuscany) Referral Center, Careggi HospitalFlorence, Italy.,Advanced Molecular Genetics Laboratory, Atherothrombotic Diseases Center, Careggi HospitalFlorence, Italy.,Center of Excellence for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies (DENOTHE), University of FlorenceFlorence, Italy
| | - Elena Sticchi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of FlorenceFlorence, Italy.,Marfan Syndrome and Related Disorders Regional (Tuscany) Referral Center, Careggi HospitalFlorence, Italy.,Advanced Molecular Genetics Laboratory, Atherothrombotic Diseases Center, Careggi HospitalFlorence, Italy.,Center of Excellence for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies (DENOTHE), University of FlorenceFlorence, Italy
| | - Rosina De Cario
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of FlorenceFlorence, Italy.,Marfan Syndrome and Related Disorders Regional (Tuscany) Referral Center, Careggi HospitalFlorence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of FlorenceFlorence, Italy.,Advanced Molecular Genetics Laboratory, Atherothrombotic Diseases Center, Careggi HospitalFlorence, Italy
| | - Stefano Nistri
- Center of Excellence for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies (DENOTHE), University of FlorenceFlorence, Italy.,Cardiology Service, Centro Medico Strumentale Riabilitativo (CMSR) Veneto MedicaAltavilla Vicentina, Italy
| | - Guglielmina Pepe
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of FlorenceFlorence, Italy.,Marfan Syndrome and Related Disorders Regional (Tuscany) Referral Center, Careggi HospitalFlorence, Italy.,Center of Excellence for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies (DENOTHE), University of FlorenceFlorence, Italy
| |
Collapse
|
23
|
Koutaka M, Hyougo H, Tsugo K, Une Y. Anomalous origin of the right coronary artery from the pulmonary artery and congenital bicuspid aortic valve in a California sea lion (Zalophus californianus). J Vet Med Sci 2017; 79:1559-1562. [PMID: 28781293 PMCID: PMC5627328 DOI: 10.1292/jvms.16-0522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 27-year-old captive female California sea lion (Zalophus californianus) died suddenly. Necropsy findings showed severe hemopericardium, the right coronary artery arose from the sinus of the pulmonary trunk, and the aortic valve was composed of two semilunar cusps. Coronary artery branches emerging from the epicardium were dilated and tortuous. Pampiniform vascular plexus formation existed along the adventitia from the coronal sulcus to the pulmonary trunk. This is the first report of multiple congenital cardiac malformations with an anomalous origin of the right coronary artery from the pulmonary artery and a bicuspid aortic valve in a marine mammal.
Collapse
Affiliation(s)
- Mitsuru Koutaka
- Marine World Umino-nakamichi, 18-28 Saitozaki, Higashi-ku, Fukuoka-shi, Fukuoka 811-0321, Japan
| | - Hanami Hyougo
- Laboratory of Veterinary Pathology, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Kousuke Tsugo
- Laboratory of Veterinary Pathology, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Yumi Une
- Laboratory of Veterinary Pathology, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| |
Collapse
|
24
|
|
25
|
Martín M, Lorca R, Rozado J, Alvarez-Cabo R, Calvo J, Pascual I, Cigarrán H, Rodríguez I, Morís C. Bicuspid aortic valve syndrome: a multidisciplinary approach for a complex entity. J Thorac Dis 2017; 9:S454-S464. [PMID: 28616342 DOI: 10.21037/jtd.2017.05.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Bicuspid aortic valve (BAV) or bicuspid aortopathy is the most common congenital heart disease. It can be clinically silent and it is often identified as an incidental finding in otherwise healthy, asymptomatic patients. However, it can be dysfunctioning at birth, even requiring neonatal intervention, or, in time, lead to aortic stenosis, aortic insufficiency, and endocarditis, and also be associated with aortic aneurysm and aortic dissection. Given its prevalence and significant complications, it is estimated that BAV is responsible for more deaths and morbidity than the combined effects of all the other congenital heart defects. Pathology of BAV is still not well known and many questions are unresolved. In this manuscript we review some aspects on bicuspid aortopathy, a heterogeneous and frequent disease in which like some authors have previously described, complex gene environment are present. Further investigations and, what is more, multidisciplinary teams are needed to improve our knowledge on this really fascinating disease.
Collapse
Affiliation(s)
- María Martín
- Cardiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Rebeca Lorca
- Cardiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - José Rozado
- Cardiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Rubén Alvarez-Cabo
- Cardiac Surgery Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Juan Calvo
- Radiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Cardiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Helena Cigarrán
- Radiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Isabel Rodríguez
- Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - César Morís
- Cardiology Department, Instituto Reina Sofía de Investigación Nefrológica, REDinREN from ISCIII. Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
26
|
Mesenchymal state of intimal cells may explain higher propensity to ascending aortic aneurysm in bicuspid aortic valves. Sci Rep 2016; 6:35712. [PMID: 27779199 PMCID: PMC5078843 DOI: 10.1038/srep35712] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/04/2016] [Indexed: 12/25/2022] Open
Abstract
Individuals with a bicuspid aortic valve (BAV) are at significantly higher risk of developing aortic complications than individuals with tricuspid aortic valves (TAV) and defective signaling during the embryonic development and/or life time exposure to abnormal hemodynamic have been proposed as underlying factors. However, an explanation for the molecular mechanisms of aortopathy in BAV has not yet been provided. We combined proteomics, RNA analyses, immunohistochemistry, and electron microscopy to identify molecular differences in samples of non-dilated ascending aortas from BAV (N = 62) and TAV (N = 54) patients. Proteomic analysis was also performed for dilated aortas (N = 6 BAV and N = 5 TAV) to gain further insight into the aortopathy of BAV. Our results collectively showed the molecular signature of an endothelial/epithelial-mesenchymal (EndMT/EMT) transition-like process, associated with instability of intimal cell junctions and activation of RHOA pathway in the intima and media layers of ascending aorta in BAV patients. We propose that an improper regulation of EndMT/EMT during the spatiotemporally related embryogenesis of semilunar valves and ascending aorta in BAV individuals may result in aortic immaturity and instability prior to dilation. Exasperation of EndMT/EMT state in post embryonic life and/or exposure to non-physiological hemodynamic could lead to the aneurysm of ascending aorta in BAV individuals.
Collapse
|
27
|
Freeze SL, Landis BJ, Ware SM, Helm BM. Bicuspid Aortic Valve: a Review with Recommendations for Genetic Counseling. J Genet Couns 2016; 25:1171-1178. [PMID: 27550231 DOI: 10.1007/s10897-016-0002-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 07/31/2016] [Indexed: 12/16/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect and falls in the spectrum of left-sided heart defects, also known as left ventricular outflow tract obstructive (LVOTO) defects. BAV is often identified in otherwise healthy, asymptomatic individuals, but it is associated with serious long term health risks including progressive aortic valve disease (stenosis or regurgitation) and thoracic aortic aneurysm and dissection. BAV and other LVOTO defects have high heritability. Although recommendations for cardiac screening of BAV in at-risk relatives exist, there are no standard guidelines for providing genetic counseling to patients and families with BAV. This review describes current knowledge of BAV and associated aortopathy and provides guidance to genetic counselors involved in the care of patients and families with these malformations. The heritability of BAV and recommendations for screening are highlighted. While this review focuses specifically on BAV, the principles are applicable to counseling needs for other LVOTO defects.
Collapse
Affiliation(s)
- Samantha L Freeze
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin J Landis
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medical & Molecular Genetics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 975 West Walnut Street, IB-130, Indianapolis, IN, 46202, USA
| | - Stephanie M Ware
- Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medical & Molecular Genetics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 975 West Walnut Street, IB-130, Indianapolis, IN, 46202, USA
| | - Benjamin M Helm
- Department of Medical & Molecular Genetics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 975 West Walnut Street, IB-130, Indianapolis, IN, 46202, USA.
| |
Collapse
|
28
|
Bicuspid Aortic Valve: Unlocking the Morphogenetic Puzzle. Am J Med 2016; 129:796-805. [PMID: 27059385 DOI: 10.1016/j.amjmed.2016.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 11/23/2022]
Abstract
Although bicuspid aortic valve is the most common congenital abnormality, it is perhaps erroneous to consider this disease one clinical entity. Rather, it may be useful to consider it a cluster of diseases incorporating different phenotypes, etiologies, and pathogenesis. Discussion of bicuspid aortic valve can be difficult because there is no clear consensus on a phenotypic description among authors, and many classification schemes have been proposed. The literature suggests that different phenotypes have different associations and clinical manifestations. In addition, recent studies suggest a genetic basis for the disease, yet few genes have so far been described. Furthermore, recent scientific literature has been focusing on the increased risk of aortic aneurysms, but the pathogenesis of bicuspid aortic valve aortopathy is still unclear. The aim of this paper is to review the current evidence about the unsolved issues around bicuspid aortic valve.
Collapse
|
29
|
Tsang HG, Rashdan NA, Whitelaw CBA, Corcoran BM, Summers KM, MacRae VE. Large animal models of cardiovascular disease. Cell Biochem Funct 2016; 34:113-32. [PMID: 26914991 PMCID: PMC4834612 DOI: 10.1002/cbf.3173] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 12/12/2022]
Abstract
The human cardiovascular system is a complex arrangement of specialized structures with distinct functions. The molecular landscape, including the genome, transcriptome and proteome, is pivotal to the biological complexity of both normal and abnormal mammalian processes. Despite our advancing knowledge and understanding of cardiovascular disease (CVD) through the principal use of rodent models, this continues to be an increasing issue in today's world. For instance, as the ageing population increases, so does the incidence of heart valve dysfunction. This may be because of changes in molecular composition and structure of the extracellular matrix, or from the pathological process of vascular calcification in which bone-formation related factors cause ectopic mineralization. However, significant differences between mice and men exist in terms of cardiovascular anatomy, physiology and pathology. In contrast, large animal models can show considerably greater similarity to humans. Furthermore, precise and efficient genome editing techniques enable the generation of tailored models for translational research. These novel systems provide a huge potential for large animal models to investigate the regulatory factors and molecular pathways that contribute to CVD in vivo. In turn, this will help bridge the gap between basic science and clinical applications by facilitating the refinement of therapies for cardiovascular disease.
Collapse
Affiliation(s)
- H G Tsang
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, SCT, UK
| | - N A Rashdan
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, SCT, UK
| | - C B A Whitelaw
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, SCT, UK
| | - B M Corcoran
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, SCT, UK
| | - K M Summers
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, SCT, UK
| | - V E MacRae
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, SCT, UK
| |
Collapse
|
30
|
Gharibeh L, El-Rassy I, Soubra A, Safa R, Fahed A, Tanos R, Arabi M, Kambris Z, Bitar F, Nemer G. A novel nonsense mutation in NPHS1: is aortic stenosis associated with congenital nephropathy? J Genet 2015; 94:309-12. [PMID: 26174680 DOI: 10.1007/s12041-015-0514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lara Gharibeh
- Department of Biochemistry and Molecular Genetics, American University of Beirut, P.O. Box 11-0236 Beirut, Lebanon.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Mathieu P, Bossé Y, Huggins GS, Della Corte A, Pibarot P, Michelena HI, Limongelli G, Boulanger MC, Evangelista A, Bédard E, Citro R, Body SC, Nemer M, Schoen FJ. The pathology and pathobiology of bicuspid aortic valve: State of the art and novel research perspectives. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2015; 1:195-206. [PMID: 27499904 PMCID: PMC4939890 DOI: 10.1002/cjp2.21] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/25/2015] [Indexed: 12/12/2022]
Abstract
Bicuspid aortic valve is the most prevalent cardiac valvular malformation. It is associated with a high rate of long‐term morbidity including development of calcific aortic valve disease, aortic regurgitation and concomitant thoracic aortic aneurysm and dissection. Recently, basic and translational studies have identified some key processes involved in the development of bicuspid aortic valve and its morbidity. The development of aortic valve disease and thoracic aortic aneurysm and dissection is the result of complex interactions between genotypes, environmental risk factors and specific haemodynamic conditions created by bicuspid aortic valve anatomy. Herein, we review the pathobiology of bicuspid aortic valve with a special emphasis on translational aspects of these basic findings. Important but unresolved problems in the pathology of bicuspid aortic valve and thoracic aortic aneurysm and dissection are discussed, along with the molecular processes involved.
Collapse
Affiliation(s)
- Patrick Mathieu
- Laboratoire d'Études Moléculaires des Valvulopathies (LEMV), Groupe de Recherche en Valvulopathies (GRV), Department of Surgery Quebec Heart and Lung Institute/Research Center, Laval University Quebec Canada
| | - Yohan Bossé
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Gordon S Huggins
- Molecular Cardiology Research Institute Center for Translational Genomics, Tufts Medical Center Boston Massachussetts USA
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Cardiac Surgery Second University of Naples 80131 Naples Italy
| | - Philippe Pibarot
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic Rochester Minnesota USA
| | - Giuseppe Limongelli
- Department of Cardiology and Cardiothoracic and Respiratory Sciences, Cardiologia SUN, Monaldi Hospital, AO Colli Naples Italy
| | - Marie-Chloé Boulanger
- Laboratoire d'Études Moléculaires des Valvulopathies (LEMV), Groupe de Recherche en Valvulopathies (GRV), Department of Surgery Quebec Heart and Lung Institute/Research Center, Laval University Quebec Canada
| | - Arturo Evangelista
- Department of Cardiology Hospital Universitary Vall d'Hebron Barcelona Spain
| | - Elisabeth Bédard
- Department of Molecular Medicine, Quebec Heart and Lung Institute/Research Center Laval University Québec Canada
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine Center for Perioperative Genomics, Brigham and Women's Hospital Boston Massachusetts USA
| | - Mona Nemer
- Laboratory for Cardiac Development and Differentiation University of Ottawa Ontario Canada
| | - Frederick J Schoen
- Department of Pathology Brigham and Women's Hospital, Harvard Medical School USA
| |
Collapse
|
32
|
Paloschi V, Gådin JR, Khan S, Björck HM, Du L, Maleki S, Roy J, Lindeman JHM, Mohamed SA, Tsuda T, Franco-Cereceda A, Eriksson P. Aneurysm development in patients with a bicuspid aortic valve is not associated with transforming growth factor-β activation. Arterioscler Thromb Vasc Biol 2015; 35:973-80. [PMID: 25745062 DOI: 10.1161/atvbaha.114.304996] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Patients with bicuspid aortic valve (BAV) have an increased risk of developing ascending aortic aneurysms. Transforming growth factor-β (TGFβ) is a crucial factor of vascular remodeling, the impaired signaling of which can alter the structure and composition of the extracellular matrix. In this study, we analyzed the activity of TGFβ in aneurysmal and nonaneurysmal ascending aorta from BAV patients, using tricuspid aortic valve (TAV) patients as a reference group. APPROACH AND RESULTS The response to exogenous TGFβ was analyzed with regard to gene expression in primary aortic smooth muscle cells that were isolated from 7 BAV and 5 TAV patients and in valve fibroblasts from 7 BAV and 8 TAV patients. The set of genes that were significantly changed by TGFβ (217 genes) was compared with gene expression profiles of the ascending aorta from BAV and TAV patients (139 arrays). By principle component analysis, based on the 217 genes, gene expression differed significantly in the intima/media region between aneurysmal BAV and TAV aortas, driven by the response in TAV patients. During aneurysm development the levels of phosphorylated SMADs and the availability of free TGFβ were lower in BAV patients compared with TAV. Confocal microscopy analysis showed a higher colocalization of latency associated peptide and latent TGFβ binding protein 3 in BAV aortas. CONCLUSIONS Our findings suggest that TGFβ activation during aneurysm formation is muted in patients with BAV, possibly as a result of an increased TGFβ sequestration in the extracellular space.
Collapse
Affiliation(s)
- Valentina Paloschi
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.).
| | - Jesper R Gådin
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Shaukat Khan
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Hanna M Björck
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Lei Du
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Shohreh Maleki
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Joy Roy
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Jan H M Lindeman
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Salah A Mohamed
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Takeshi Tsuda
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Anders Franco-Cereceda
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| | - Per Eriksson
- From the Atherosclerosis Research Unit, Department of Medicine, Center for Molecular Medicine (V.P., J.R.G., H.M.B., L.D., S.M., P.E.), Vascular Surgery Section, Department of Molecular Medicine and Surgery (J.R.), and Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery (A.F.-C.), Karolinska Institutet, Stockholm, Sweden; Center for Cardiac Research, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, DE (S.K., T.T.); Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (J.H.M.L.); and Department of Cardiac Surgery, University Clinic of Schleswig-Holstein Campus Luebeck, Luebeck, Germany (S.A.M.)
| |
Collapse
|
33
|
Saenen J, Van Craenenbroeck E, Proost D, Marchau F, Van Laer L, Vrints C, Loeys B. Genetics of sudden cardiac death in the young. Clin Genet 2014; 88:101-13. [DOI: 10.1111/cge.12519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J.B. Saenen
- Department of Cardiology; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| | - E.M. Van Craenenbroeck
- Department of Cardiology; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| | - D. Proost
- Center for Medical Genetics; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| | - F. Marchau
- Department of Pediatric Cardiology; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| | - L. Van Laer
- Center for Medical Genetics; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| | - C.J. Vrints
- Department of Cardiology; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| | - B.L. Loeys
- Center for Medical Genetics; Antwerp University Hospital/University of Antwerp; Antwerp Belgium
| |
Collapse
|
34
|
Review of Molecular and Mechanical Interactions in the Aortic Valve and Aorta: Implications for the Shared Pathogenesis of Aortic Valve Disease and Aortopathy. J Cardiovasc Transl Res 2014; 7:823-46. [DOI: 10.1007/s12265-014-9602-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/30/2014] [Indexed: 01/08/2023]
|
35
|
Prakash SK, Bossé Y, Muehlschlegel JD, Michelena HI, Limongelli G, Della Corte A, Pluchinotta FR, Russo MG, Evangelista A, Benson DW, Body SC, Milewicz DM. A roadmap to investigate the genetic basis of bicuspid aortic valve and its complications: insights from the International BAVCon (Bicuspid Aortic Valve Consortium). J Am Coll Cardiol 2014; 64:832-9. [PMID: 25145529 DOI: 10.1016/j.jacc.2014.04.073] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/06/2014] [Accepted: 04/21/2014] [Indexed: 12/16/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common adult congenital heart defect and is found in 0.5% to 2.0% of the general population. The term "BAV" refers to a heterogeneous group of disorders characterized by diverse aortic valve malformations with associated aortopathy, congenital heart defects, and genetic syndromes. Even after decades of investigation, the genetic determinants of BAV and its complications remain largely undefined. Just as BAV phenotypes are highly variable, the genetic etiologies of BAV are equally diverse and vary from complex inheritance in families to sporadic cases without any evidence of inheritance. In this paper, the authors discuss current concepts in BAV genetics and propose a roadmap for unraveling unanswered questions about BAV through the integrated analysis of genetic and clinical data.
Collapse
Affiliation(s)
- Siddharth K Prakash
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Yohan Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Molecular Medicine, Laval University, Québec City, Québec, Canada
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Giuseppe Limongelli
- Department of Cardiology, Second University of Naples and Monaldi Hospital, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples and Monaldi Hospital, Naples, Italy
| | - Francesca R Pluchinotta
- Division of Pediatric Cardiology and Congenital Heart Disease in Adults, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Second University of Naples and Monaldi Hospital, Naples, Italy
| | - Artur Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - D Woodrow Benson
- Herma Heart Center, Children's Hospital of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dianna M Milewicz
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | | |
Collapse
|
36
|
Milin AC, Vorobiof G, Aksoy O, Ardehali R. Insights into aortic sclerosis and its relationship with coronary artery disease. J Am Heart Assoc 2014; 3:e001111. [PMID: 25193296 PMCID: PMC4323780 DOI: 10.1161/jaha.114.001111] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Alexandra C Milin
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| | - Gabriel Vorobiof
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| | - Olcay Aksoy
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| | - Reza Ardehali
- Department of Internal Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA
| |
Collapse
|
37
|
Michelena HI, Prakash SK, Della Corte A, Bissell MM, Anavekar N, Mathieu P, Bossé Y, Limongelli G, Bossone E, Benson DW, Lancellotti P, Isselbacher EM, Enriquez-Sarano M, Sundt TM, Pibarot P, Evangelista A, Milewicz DM, Body SC. Bicuspid aortic valve: identifying knowledge gaps and rising to the challenge from the International Bicuspid Aortic Valve Consortium (BAVCon). Circulation 2014; 129:2691-704. [PMID: 24958752 PMCID: PMC4145814 DOI: 10.1161/circulationaha.113.007851] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Hector I Michelena
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.).
| | - Siddharth K Prakash
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Alessandro Della Corte
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Malenka M Bissell
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Nandan Anavekar
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Patrick Mathieu
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Yohan Bossé
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Giuseppe Limongelli
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Eduardo Bossone
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - D Woodrow Benson
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Patrizio Lancellotti
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Eric M Isselbacher
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Maurice Enriquez-Sarano
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Thoralf M Sundt
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Philippe Pibarot
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Artur Evangelista
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Dianna M Milewicz
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| | - Simon C Body
- From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (H.I.M., N.A., M.E.-S.); Division of Medical Genetics; Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX (S.K.P., D.M.M.); Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy (A.D.C.); Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (M.M.B.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada (P.M., Y.B., P.P.); Cardiologia SUN, Monaldi Hospital, Naples, Italy (G.L.); Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno, Italy (E.B.); Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI (D.W.B.); University Hospital of Liège, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium (P.L.); Heart Center and Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); Division of Cardiac Surgery and Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA (T.M.S.); Servei de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (A.E.); and Dept of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.C.B.)
| |
Collapse
|
38
|
Identification of fibrillin 1 gene mutations in patients with bicuspid aortic valve (BAV) without Marfan syndrome. BMC MEDICAL GENETICS 2014; 15:23. [PMID: 24564502 PMCID: PMC3937520 DOI: 10.1186/1471-2350-15-23] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022]
Abstract
Background Bicuspid aortic valve (BAV) is the most frequent congenital heart disease with frequent involvement in thoracic aortic dilatation, aneurysm and dissection. Although BAV and Marfan syndrome (MFS) share some clinical features, and some MFS patients with BAV display mutations in FBN1, the gene encoding fibrillin-1, the genetic background of isolated BAV is poorly defined. Methods Ten consecutive BAV patients [8 men, age range 24–42 years] without MFS were clinically characterized. BAV phenotype and function, together with evaluation of aortic morphology, were comprehensively assessed by Doppler echocardiography. Direct sequencing of each FBN1 exon with flanking intron sequences was performed on eight patients. Results We detected three FBN1 mutations in two patients (aged 24 and 25 years) displaying aortic root aneurysm ≥50 mm and moderate aortic regurgitation. In particular, one patient had two mutations (p.Arg2726Trp and p.Arg636Gly) one of which has been previously associated with variable Marfanoid phenotypes. The other patient showed a pArg529Gln substitution reported to be associated with an incomplete MFS phenotype. Conclusions The present findings enlarge the clinical spectrum of isolated BAV to include patients with BAV without MFS who have involvement of FBN1 gene. These results underscore the importance of accurate phenotyping of BAV aortopathy and of clinical characterization of BAV patients, including investigation of systemic connective tissue manifestations and genetic testing.
Collapse
|
39
|
Agarwal A, Khandheria BK, Paterick TE, Treiber SC, Bush M, Tajik AJ. Left Ventricular Noncompaction in Patients with Bicuspid Aortic Valve. J Am Soc Echocardiogr 2013; 26:1306-13. [DOI: 10.1016/j.echo.2013.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 01/15/2023]
|
40
|
Padang R, Bannon PG, Jeremy R, Richmond DR, Semsarian C, Vallely M, Wilson M, Yan TD. The genetic and molecular basis of bicuspid aortic valve associated thoracic aortopathy: a link to phenotype heterogeneity. Ann Cardiothorac Surg 2013; 2:83-91. [PMID: 23977563 DOI: 10.3978/j.issn.2225-319x.2012.11.17] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/30/2012] [Indexed: 12/17/2022]
Affiliation(s)
- Ratnasari Padang
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia; ; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; ; Agnes Ginges Centre for Molecular Cardiology, Centenary Institute; ; Sydney Medical School, University of Sydney, Australia
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Paterick TE, Humphries JA, Ammar KA, Jan MF, Loberg R, Bush M, Khandheria BK, Tajik AJ. Aortopathies: etiologies, genetics, differential diagnosis, prognosis and management. Am J Med 2013; 126:670-8. [PMID: 23800581 DOI: 10.1016/j.amjmed.2013.01.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 01/15/2023]
Abstract
Aortic root and ascending aortic dilatation are indicators associated with risk of aortic dissection, which varies according to underlying etiologic associations, indexed aortic root size, and rate of progression. Typical aortic involvement is most commonly seen in syndromic cases for which there is increasing evidence that aortic aneurysm represents a spectrum of familial inheritance associated with variable genetic penetrance and phenotypic expression. Aortic root and ascending aortic dimensions should be measured routinely with echocardiography. Pharmacologic therapy may reduce the rate of progression. Timing of surgical intervention is guided by indexed aortic size and rate of change of aortic root and ascending aorta dimensions. Lifelong surveillance is recommended.
Collapse
Affiliation(s)
- Timothy E Paterick
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Maleki S, Björck HM, Paloschi V, Kjellqvist S, Folkersen L, Jackson V, Franco-Cereceda A, Eriksson P. Aneurysm Development in Patients With Bicuspid Aortic Valve (BAV): Possible Connection to Repair Deficiency? AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2013; 1:13-22. [PMID: 26798668 DOI: 10.12945/j.aorta.2013.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/15/2013] [Indexed: 01/25/2023]
Affiliation(s)
- Shohreh Maleki
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M Björck
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Paloschi
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sanela Kjellqvist
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lasse Folkersen
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Jackson
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
43
|
Foffa I, Ait Alì L, Panesi P, Mariani M, Festa P, Botto N, Vecoli C, Andreassi MG. Sequencing of NOTCH1, GATA5, TGFBR1 and TGFBR2 genes in familial cases of bicuspid aortic valve. BMC MEDICAL GENETICS 2013; 14:44. [PMID: 23578328 PMCID: PMC3637327 DOI: 10.1186/1471-2350-14-44] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/02/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of our study was to investigate the potential contribution of germline mutations in NOTCH1, GATA5 and TGFBR1 and TGFBR2 genes in a cohort of Italian patients with familial Bicuspid Aortic Valve (BAV). METHODS All the coding exons including adjacent intronic as well as 5' and 3' untranslated (UTR) sequences of NOTCH1, GATA5, TGFBR1 and TGFBR2 genes were screened by direct gene sequencing in 11 index patients (8 males; age = 42 ± 19 years) with familial BAV defined as two or more affected members. RESULTS Two novel mutations, a missense and a nonsense mutation (Exon 5, p.P284L; Exon 26, p.Y1619X), were found in the NOTCH1 gene in two unrelated families. The mutations segregated with the disease in these families, and they were not found on 200 unrelated chromosomes from ethnically matched controls. No pathogenetic mutation was identified in GATA5, TGFBR1 and TGFBR2 genes. CONCLUSIONS Two novel NOTCH1 mutations were identified in two Italian families with BAV, highlighting the role of a NOTCH1 signaling pathway in BAV and its aortic complications. These findings are of relevance for genetic counseling and clinical care of families presenting with BAV. Future studies are needed in order to unravel the still largely unknown genetics of BAV.
Collapse
Affiliation(s)
- Ilenia Foffa
- CNR Istituto di Fisiologia Clinica, Via Moruzzi 1, Pisa 56124, Italy
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Navarra E, El Khoury G, Glineur D, Boodhwani M, Van Dyck M, Vanoverschelde JL, Noirhomme P, de Kerchove L. Effect of annulus dimension and annuloplasty on bicuspid aortic valve repair†. Eur J Cardiothorac Surg 2013; 44:316-22; discussion 322-3. [DOI: 10.1093/ejcts/ezt045] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|