Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta.
Department of Cardiac Sciences.
Curr Opin Cardiol. 2019 Mar;34(2):124-131. doi: 10.1097/HCO.0000000000000601.
Bicuspid aortic valve (BAV) results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as BAV-associated aortopathy, or bicuspid aortopathy. Bicuspid aortopathy is progressive, increasing the risk of life-threatening clinical events, such as aortic dissection. Regular monitoring and timely intervention with prophylactic surgical resection of the proximal aorta is recommended.
Aortopathy is heterogeneous among patients. Studies have shown that different flow patterns lead to specific phenotypes of aortopathy. Although not uniform, BAV morphology affects flow patterns. Recent work has demonstrated the role of wall shear stress (WSS) in driving aortopathy, and it is suggested that individualized WSS 'heat maps' can be used for clinically monitoring patients with BAV. WSS has the potential to be an imaging biomarker for directing resection timing, surgical strategies, and postsurgical follow-up care.
Finding and validating noninvasive hemodynamic biomarkers of aortic risk to assist in the management of BAV patients is of clinical importance. Herein, we will review the latest findings pertaining to the utility of WSS as a specific biomarker of risk for BAV patients with aortopathy.
二叶式主动脉瓣（BAV）由两个相邻的主动脉瓣叶融合而成，与主动脉扩张有关，称为二叶式主动脉瓣相关主动脉病变或二叶式主动脉瓣病。二叶式主动脉瓣病是进行性的，增加了危及生命的临床事件的风险，如主动脉夹层。建议定期监测，并及时进行预防性近端主动脉切除术干预。
患者的主动脉病变存在异质性。研究表明，不同的血流模式导致特定的主动脉病变表型。尽管并不统一，但 BAV 形态会影响血流模式。最近的研究表明壁面切应力（WSS）在驱动主动脉病变中的作用，并提出可以使用个性化的 WSS“热图”来对 BAV 患者进行临床监测。WSS 有可能成为指导切除术时机、手术策略和术后随访护理的影像学生物标志物。
寻找和验证主动脉风险的非侵入性血流动力学生物标志物，以协助 BAV 患者的管理具有临床重要性。本文将综述最新研究发现，即 WSS 作为二叶式主动脉瓣病患者主动脉病变风险的特定生物标志物的应用。
