Fatehi Hassanabad Ali, Barker Alex J, Guzzardi David, Markl Michael, Malaisrie Chris, McCarthy Patrick M, Fedak Paul W M
Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of CalgaryCalgary, AB, Canada.
Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, United States.
Front Physiol. 2017 Jul 10;8:475. doi: 10.3389/fphys.2017.00475. eCollection 2017.
Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1-2% of people. BAV results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as bicuspid valve associated aortopathy. Bicuspid valve aortopathy is progressive and associated with catastrophic clinical events, such as aortic dissection and rupture. Therefore, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. However, the specific pattern of aortopathy is highly variable among patients, with different segments of the ascending aorta being affected. Individual patient risks are sometimes difficult to predict. Resection strategies are informed by current surgical guidelines which are primarily based on aortic size and growth criteria. These criteria may not optimally reflect the risk of important aortic events. To address these issues in the care of patients with bicuspid valve aortopathy, our translational research group has focused on validating use of novel imaging techniques to establish non-invasive hemodynamic biomarkers for risk-stratifying BAV patients. In this article, we review recent efforts, successes, and ongoing challenges in the development of more precise and individualized surgical approaches for patients with bicuspid aortic valves and associated aortic disease.
二叶式主动脉瓣（BAV）是一种常见的先天性心脏畸形，影响着1%至2%的人群。BAV是由两个相邻的主动脉瓣叶融合而成，并与主动脉扩张有关，即所谓的二叶式瓣膜相关主动脉病变。二叶式瓣膜主动脉病变呈进行性发展，且与诸如主动脉夹层和破裂等灾难性临床事件相关。因此，通常建议进行频繁监测，并尽早对升主动脉进行预防性手术切除干预。然而，患者之间主动脉病变的具体模式差异很大，升主动脉的不同节段都会受到影响。有时很难预测个体患者的风险。手术策略依据当前主要基于主动脉大小和生长标准的手术指南制定。这些标准可能无法最佳地反映重要主动脉事件的风险。为了解决二叶式瓣膜主动脉病变患者护理中的这些问题，我们的转化研究团队专注于验证新型成像技术的应用，以建立用于对BAV患者进行风险分层的非侵入性血流动力学生物标志物。在本文中，我们回顾了为患有二叶式主动脉瓣及相关主动脉疾病的患者开发更精确、个性化手术方法方面的近期努力、取得的成功以及持续存在的挑战。
