Post-stenotic aortic dilatation.
Aortic stenosis is the most common valvular heart disease affecting up to 4% of the elderly population. It can be associated with dilatation of the ascending aorta and subsequent dissection. Post-stenotic dilatation is seen in patients with AS and/or aortic regurgitation, patients with a haemodynamically normal bicuspid aortic valve and following aortic valve replacement. Controversy exists as to whether to replace the aortic root and ascending aorta at the time of aortic valve replacement, an operation that potentially carries a higher morbidity and mortality. The aetiology of post-stenotic aortic dilatation remains controversial. It may be due to haemodynamic factors caused by a stenotic valve, involving high velocity and turbulent flow downstream of the stenosis, or due to intrinsic pathology of the aortic wall. This may involve an abnormality in the process of extracellular matrix remodelling in the aortic wall including inadequate synthesis, degradation and transport of extracellular matrix proteins. This article reviews the aetiology, pathology and management of patients with post-stenotic aortic dilatation.
Wilton
Emma
E
Department of Cardiothoracic Surgery, St, George's Hospital and Medical School, London, UK. eswilton@doctors.org.uk
Jahangiri
Marjan
M
D000818:Animals; D001013:Aorta, Thoracic / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001018:Aortic Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology*; D015897:Comorbidity; D004108:Dilatation, Pathologic / Q000453:epidemiology; D000071837:Fibrillins; D006330:Heart Defects, Congenital / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D006439:Hemodynamics; D006801:Humans; D020782:Matrix Metalloproteinases / Q000378:metabolism; D008840:Microfilament Proteins / Q000235:genetics
D000071837:Fibrillins; D008840:Microfilament Proteins; D020782:Matrix Metalloproteinases