Stock Sina, Mohamed Salah A, Sievers Hans-Hinrich
Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Gen Thorac Cardiovasc Surg. 2019 Jan;67(1):93-101. doi: 10.1007/s11748-017-0821-x. Epub 2017 Aug 30.
Bicuspid aortic valve related aortopathy is known to significantly increase the risk for catastrophic aortic events and, therefore, represents a considerable health burden. Albeit of ongoing research in this field including genetic, molecular, hemodynamic and morphologic aspects, bicuspid aortic valve related aortopathy still represents an imperfectly understood disorder. This lack in knowledge results in a lack of consistency considering different therapeutic approaches. Recent studies have provided new insights into the etiology and clinical impacts of bicuspid aortic valve related aortopathy in different clinical settings, leading to a growing body of opinion towards a more individualized surgical approach than currently provided by the guidelines. Especially valvular hemodynamics-stenosis and regurgitation-seem to have significant impact on the development of bicuspid aortic valve related aortopathy. In this context, there is evidence that regurgitation of bicuspid aortic valves is the more fatal pathomechanism. Furthermore, "age" represents an aspect that should be taken into account when deciding whether to replace the aorta or not, because the diameter depends mainly on a patients age. The same diameter of the aorta in a 70-year old and a 20-year old patient has to be interpreted differently and should, therefore, result in different therapeutic strategies.
已知二叶式主动脉瓣相关主动脉病变会显著增加发生灾难性主动脉事件的风险，因此是一个相当大的健康负担。尽管该领域正在进行包括遗传、分子、血流动力学和形态学方面的研究，但二叶式主动脉瓣相关主动脉病变仍是一种尚未完全了解的病症。这种知识上的欠缺导致在考虑不同治疗方法时缺乏一致性。最近的研究为不同临床环境中二叶式主动脉瓣相关主动脉病变的病因和临床影响提供了新的见解，使得越来越多的人倾向于采用比目前指南所提供的更为个体化的手术方法。特别是瓣膜血流动力学——狭窄和反流——似乎对二叶式主动脉瓣相关主动脉病变的发展有重大影响。在这种情况下，有证据表明二叶式主动脉瓣反流是更致命的发病机制。此外，“年龄”是决定是否更换主动脉时应考虑的一个因素，因为主动脉直径主要取决于患者年龄。对于一名70岁和一名20岁的患者，相同直径的主动脉必须有不同的解读，因此应该导致不同的治疗策略。
