Aortopathies: etiologies, genetics, differential diagnosis, prognosis and management

Am J Med. 2013 Aug;126(8):670-8. doi: 10.1016/j.amjmed.2013.01.029. Epub 2013 Jun 22.

Abstract

Aortic root and ascending aortic dilatation are indicators associated with risk of aortic dissection, which varies according to underlying etiologic associations, indexed aortic root size, and rate of progression. Typical aortic involvement is most commonly seen in syndromic cases for which there is increasing evidence that aortic aneurysm represents a spectrum of familial inheritance associated with variable genetic penetrance and phenotypic expression. Aortic root and ascending aortic dimensions should be measured routinely with echocardiography. Pharmacologic therapy may reduce the rate of progression. Timing of surgical intervention is guided by indexed aortic size and rate of change of aortic root and ascending aorta dimensions. Lifelong surveillance is recommended.

Keywords: Aortopathy; Bentall composite graft; Bicuspid aortic valve; Familial thoracic aneurysm; Ghent diagnostic criteria; Loeys-Dietz syndrome; MASS phenotype; Marfan syndrome.

Publication types

  • Review

MeSH terms

  • Actins / deficiency
  • Actins / genetics
  • Aortic Aneurysm / diagnosis
  • Aortic Aneurysm / genetics
  • Aortic Aneurysm / therapy*
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / genetics
  • Aortic Aneurysm, Thoracic / therapy
  • Aortic Valve / abnormalities
  • Arachnodactyly / diagnosis
  • Arachnodactyly / genetics
  • Arachnodactyly / therapy
  • Bicuspid Aortic Valve Disease
  • Contracture / diagnosis
  • Contracture / genetics
  • Contracture / therapy
  • Diagnosis, Differential
  • Ductus Arteriosus, Patent / diagnosis
  • Ductus Arteriosus, Patent / genetics
  • Ductus Arteriosus, Patent / therapy
  • Echocardiography
  • Ehlers-Danlos Syndrome / diagnosis
  • Ehlers-Danlos Syndrome / genetics
  • Ehlers-Danlos Syndrome / therapy
  • Heart Valve Diseases / diagnosis
  • Heart Valve Diseases / genetics
  • Heart Valve Diseases / therapy
  • Humans
  • Iris / abnormalities
  • Livedo Reticularis / diagnosis
  • Livedo Reticularis / genetics
  • Livedo Reticularis / therapy
  • Loeys-Dietz Syndrome / diagnosis
  • Loeys-Dietz Syndrome / genetics
  • Loeys-Dietz Syndrome / therapy
  • Marfan Syndrome / diagnosis
  • Marfan Syndrome / genetics
  • Marfan Syndrome / therapy
  • Mitral Valve Prolapse / diagnosis
  • Mitral Valve Prolapse / genetics
  • Mitral Valve Prolapse / therapy
  • Myopia / diagnosis
  • Myopia / genetics
  • Myopia / therapy
  • Prognosis
  • Skin Diseases / diagnosis
  • Skin Diseases / genetics
  • Skin Diseases / therapy

Substances

  • Actins

Supplementary concepts

  • Aortic Aneurysm, Familial Thoracic 6
  • Congenital contractural arachnodactyly
  • MASS syndrome