Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Vall d'Hebron Institut de Recerca, Barcelona, Spain.
J Am Coll Cardiol. 2023 Aug 1;82(5):448-464. doi: 10.1016/j.jacc.2022.10.042.
Bicuspid aortic valve is the most common congenital heart disease and exposes patients to an increased risk of aortic dilation and dissection. Aortic dilation is a slow, silent process, leading to a greater risk of aortic dissection. The prevention of adverse events together with optimization of the frequency of the required lifelong imaging surveillance are important for both clinicians and patients and motivated extensive research to shed light on the physiopathologic processes involved in bicuspid aortic valve aortopathy. Two main research hypotheses have been consolidated in the last decade: one supports a genetic basis for the increased prevalence of dilation, in particular for the aortic root, and the second supports the damaging impact on the aortic wall of altered flow dynamics associated with these structurally abnormal valves, particularly significant in the ascending aorta. Current opinion tends to rule out mutually excluding causative mechanisms, recognizing both as important and potentially clinically relevant.
二叶式主动脉瓣是最常见的先天性心脏病，使患者主动脉扩张和夹层的风险增加。主动脉扩张是一个缓慢、无声的过程，导致主动脉夹层的风险更大。预防不良事件以及优化所需终身影像学监测的频率对临床医生和患者都很重要，并促使广泛的研究揭示二叶式主动脉瓣主动脉瓣病变中涉及的病理生理过程。在过去的十年中，已经确立了两个主要的研究假设：一个支持扩张（特别是主动脉根部）的高发率的遗传基础，另一个支持与这些结构异常瓣膜相关的血流动力学改变对主动脉壁的破坏性影响，在升主动脉中尤为显著。目前的观点倾向于排除相互排斥的因果机制，认为两者都很重要，并且具有潜在的临床相关性。
