Early surgical experience with Loeys-Dietz: a new syndrome of aggressive thoracic aortic aneurysm disease.
BACKGROUND
Loeys-Dietz syndrome (LDS) is a recently described genetic aortic aneurysm syndrome resulting from mutations in receptors for the cytokine transforming growth factor-beta. Phenotypic features include a bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity, but risk of thoracic aortic rupture and dissection is the principle focus of management and exceeds that of most known connective tissue disorders. Our surgical experience with LDS was reviewed to assess outcomes and develop guidelines for management of this aggressive disease.


METHODS
We retrospectively reviewed medical records of all LDS patients from two institutions and obtained follow-up data from medical records and patient contacts.


RESULTS
Clinical criteria and genotyping were used to identify 71 patients. Before surgical intervention, 6 patients (9%) died from aneurysm rupture or dissection, which occurred in several patients with aortic diameters of less than 4.5 cm and as early as 6 months of age. Thoracic aortic aneurysm surgery was performed in 14 children and 7 adults. Operations included valve-sparing root replacement (VSRR) in 13, Bentall procedure in 5, arch replacement in 2, and VSRR with arch replacement in 1. There were no deaths at the primary operation, although 3 patients died 2, 5, and 11 years after surgery from rupture of the descending thoracic (n = 2) or abdominal aorta (n = 1).


CONCLUSIONS
LDS is an aggressive aortic aneurysm disease with a propensity toward rupture and dissection at a younger age and smaller aortic diameters than in other connective tissue disorders, particularly in the ascending aorta. Early recognition of the phenotype, prophylactic intervention, and meticulous surveillance of the distal aorta and vascular tree are warranted for optimal management.
Williams
Jason A
JA
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Loeys
Bart L
BL
Nwakanma
Lois U
LU
Dietz
Harry C
HC
Spevak
Philip J
PJ
Patel
Nishant D
ND
François
Katrien
K
DeBacker
Julie
J
Gott
Vincent L
VL
Vricella
Luca A
LA
Cameron
Duke E
DE
D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality; D017545:Aortic Aneurysm, Thoracic / Q000235:genetics* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D009154:Mutation; D010641:Phenotype; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome; D016212:Transforming Growth Factor beta / Q000235:genetics*
D016212:Transforming Growth Factor beta