Petersen Johannes, Sequeira-Gross Tatiana, Naito Shiho, Reichenspurner Hermann, Girdauskas Evaldas
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Expert Rev Cardiovasc Ther. 2019 Oct;17(10):753-761. doi: 10.1080/14779072.2019.1675511. Epub 2019 Oct 14.
: Dilatation of the proximal aorta is often associated with an aortic valve disease (e.g. bicuspid aortic valve, aortic stenosis), so-called 'valve-related aortopathy.' The definition of optimal timing for surgical intervention in valve-related aortopathy remains incompletely clarified. The limited value of traditional diameter-based intervention criteria has been recognized and more sophisticated diagnostic tools are necessary.: This article aims to give an overview on the most recent literature addressing the different forms of valve-related aortopathies and the optimal timing of surgical intervention. It highlights the valve morphotype-dependent (BAV vs TAV) and the valve lesion-dependent aortopathies (stenosis vs regurgitation) and outlines the current treatment options of those pathologies. Further, this review discusses novel serological and rheological markers, potentially helping in the decision-making process in valve-related aortopathy. Systematic literature searches were performed using PubMed and Embase up to July 2019.: The combination of serological biomarkers and quantitative rheological markers for transvalvular flow eccentricity might be an additional useful tool. A possible solution for the future could be a risk score which considers body-surface-adjusted aortic diameters, activity of certain circulating biomarkers, transvalvular flow patterns, possible connective tissue disorders, and the valve morphology to define an individualized treatment strategy.
升主动脉扩张常与主动脉瓣疾病（如二叶式主动脉瓣、主动脉狭窄）相关，即所谓的“瓣膜相关性主动脉病变”。瓣膜相关性主动脉病变手术干预的最佳时机定义仍未完全明确。传统基于直径的干预标准的有限价值已得到认可，因此需要更精密的诊断工具。本文旨在概述有关瓣膜相关性主动脉病变不同形式及手术干预最佳时机的最新文献。文章强调了瓣膜形态类型相关（二叶式主动脉瓣与三叶式主动脉瓣）及瓣膜病变相关的主动脉病变（狭窄与反流），并概述了这些病变的当前治疗选择。此外，本综述讨论了新型血清学和流变学标志物，其可能有助于瓣膜相关性主动脉病变的决策过程。截至2019年7月，使用PubMed和Embase进行了系统的文献检索。血清生物标志物与经瓣膜血流偏心度的定量流变学标志物相结合可能是另一种有用的工具。未来的一个可能解决方案可能是一种风险评分，该评分考虑体表面积校正后的主动脉直径、某些循环生物标志物的活性、经瓣膜血流模式、可能的结缔组织疾病以及瓣膜形态，以确定个体化的治疗策略。
