Curr Probl Cardiol. 2021 Mar;46(3):100428. doi: 10.1016/j.cpcardiol.2019.06.002. Epub 2019 Jun 21.
The current management of aortic dilatation associated with congenital bicuspid aortic valve (bicuspid aortic valve aortopathy) is based on dimensional parameters (diameter of the aneurysm, growth of the diameter over time) and few other criteria. The disease is however heterogeneous in terms of natural and clinical history and risk of acute complications, ie aortic dissection. Dimensional criteria are now admitted to have limited value as predictors of such complications. Thus, novel principles for risk stratification have been recently investigated, including phenotypic criteria, flow-related metrics, and circulating biomarkers. A systematization of the typical anatomoclinical forms that the aortopathy can assume has led to the identification of the more severe root phenotype, associated with higher risk of progression of the aneurysm and possible higher aortic dissection risk. Four-dimensional-flow magnetic resonance imaging studies are searching for potentially clinically significant metrics of flow derangement, based on the recognized association of local abnormal shear stress with wall pathology. Other research initiatives are addressing the question whether circulating molecules could predict the presence or, more importantly, the future development of aortopathy. The present review summarizes the latest progresses in the knowledge on risk stratification of bicuspid aortic valve aortopathy, focusing on critical aspects and debated points.
目前，与先天性二叶式主动脉瓣（二叶式主动脉瓣主动脉瓣病变）相关的主动脉扩张的治疗方法基于尺寸参数（动脉瘤的直径、直径随时间的增长）和其他一些标准。然而，就自然史和临床病史以及急性并发症（即主动脉夹层）的风险而言，这种疾病具有异质性。目前已经承认，尺寸标准作为这些并发症的预测指标具有有限的价值。因此，最近已经研究了用于风险分层的新原则，包括表型标准、血流相关指标和循环生物标志物。主动脉瓣病变可能表现出的典型解剖临床形式的分类，导致了更严重的根部表型的确定，与动脉瘤进展的风险增加和可能更高的主动脉夹层风险相关。基于局部异常剪切应力与壁病理之间的公认关联，四维度磁共振成像研究正在寻找潜在具有临床意义的血流紊乱指标。其他研究计划正在解决循环分子是否可以预测主动脉瓣病变的存在，更重要的是，未来的发展。本文综述了二叶式主动脉瓣主动脉瓣病变风险分层的最新进展，重点介绍了关键方面和有争议的点。
