Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-20T06:59:22.819Z Has data issue: false hasContentIssue false

Landmark lecture: Perloff lecture: Tribute to Professor Joseph Kayle Perloff and lessons learned from him: aortopathy in adults with CHD*

Published online by Cambridge University Press:  29 December 2017

Koichiro Niwa*
Affiliation:
Department of Cardiology, Cardiovascular Center, St Luke’s International Hospital, Tokyo, Japan
*
Correspondence to: K. Niwa, MD, PhD, FAHA, FACC, FJCC, Department of Cardiology, Cardiovascular Center, St luke’s International Hospital, Tokyo 1048560, Japan. Tel: 81335415151; Fax: 81355507194; E-mail: [email protected]

Abstract

Marfan syndrome, bicuspid aortic valve, and/or coarctation of the aorta are associated with medial abnormalities of the ascending aortic or para-coarctation aorta. Medial abnormalities in the ascending aorta are prevalent in other type of patients with a variety of CHDs such as single ventricle, persistent truncus arteriosus, transposition of the great arteries, hypoplastic left heart syndrome, and tetralogy of Fallot, encompassing a wide age range and may predispose to dilatation, aneurysm, and rapture necessitating aortic valve and root surgery. These CHDs exhibit ongoing dilatation of the aortic root and reduced aortic elasticity and increased aortic stiffness that may relate to intrinsic properties of the aortic root. These aortic dilatation and increased stiffness can induce aortic aneurysm, rapture of the aorta, and aortic regurgitation, but also provoke left ventricular hypertrophy, reduced coronary artery flow, and left ventricular failure. Therefore, a new clinical entity can be used to call this association of aortic pathophysiological abnormality, aortic dilation, and aorto-left ventricular interaction – “aortopathy”.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the 2017 Seventh World Congress of Pediatric Cardiology & Cardiac Surgery (WCPCCS 2017), Barcelona, Spain, 16–21 July, 2017. Presented Friday, 21 July, 2017.

Presidents of the Japanese Society for Adult Congenital Heart Disease and Asia Pacific Society for Adult Congenital Heart Disease.

References

1. Niwa, K, Perloff, JK, Bhuta, SM, et al. Structural abnormalities of great arterial walls in congenital heart disease. Light and electron microscopic analyses. Circulation 2001; 103: 393400.Google Scholar
2. Roberts, CS, Roberts, WC. Dissection of the aorta associated with congenital malformation of the aortic valve. J Am Coll Cardiol 1991; 17: 712716.CrossRefGoogle ScholarPubMed
3. Mckusick, VA. Association of congenital bicuspid aortic valve and Erdheim’s cystic medial necrosis. Lancet 1972; I: 10261027.Google Scholar
4. Seki, M, Kurishima, C, Kawasaki, H, et al. Aortic stiffness and aortic dilation in infants and children with tetralogy of Fallot before corrective surgery: evidence for intrinsically abnormal aortic mechanical property. Eur J Cardiothorac Surg 2012; 41: 277282.Google Scholar
5. Senzaki, H, Iwamoto, Y, Ishido, H, et al. Arterial haemodynamics in patients after repair of tetralogy of Fallot: influence on left ventricular after load and aortic dilatation. Heart 2008; 94: 7074.CrossRefGoogle ScholarPubMed
6. Chong, WY, Wong, WH, Chiu, CS, et al. Aortic root dilation and aortic elastic properties in children after repair of tetralogy of Fallot. Am J Cardiol 2006; 97: 905909.Google Scholar
7. Perloff, JK. Congenital aortic stenosis. Congenital aortic regurgitation. In: Perloff JK, Marelli AJ, (eds). Clinical Recognition of Congenital Heart Disease, 6th edn. Elsevier Saunders Company, Philadelphia, PA, 2012. P7475.Google Scholar
8. Erdheim, J. Medionecrosis aortae idiopathica-cystica. Virchows Arch Pathol Anat 1930; 276: 186.CrossRefGoogle Scholar
9. Edwards, WD, Leaf, DS, Edwards, JE. Dissecting aortic aneurysm associated with congenital bicuspid aortic valve. Circulation 1978; 57: 10221025.Google Scholar
10. Hahn, RT, Roman, MJ, Mogtader, AH, et al. Association of aortic dilation with regurgitant, stenotic and functionally normal bicuspid aortic valves. J Am Coll Cardiol 1992; 19: 283288.CrossRefGoogle ScholarPubMed
11. Nistri, S, Sorbo, MD, Marin, M, et al. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 1999; 82: 1922.Google Scholar
12. Reid, RT. Bicuspid aortic valve associated with aneurysmal dilatation of the ascending aorta. Med J Aust 1952; 2: 628629.Google Scholar
13. Larson, EW, Edwards, WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984; 53: 849855.Google Scholar
14. Gurvitz, M, Chang, RK, Drant, S, et al. Frequency of aortic root dilation in children with a bicuspid aortic valve. Am J Cardiol 2004; 94: 13371340.Google Scholar
15. de Sa, M, Moshkovitz, Y, Butany, J, David, TE. Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure. J Thorac Cardiovasc Surg 1999; 118: 588594.Google Scholar
16. Elkins, RC, Thompson, DM, Lane, MM, et al. Ross operation: 16-year experience. J Thorac Cardiovasc Surg 2008; 136: 623630.CrossRefGoogle Scholar
17. David, TE, Omran, A, Ivanov, J, et al. Dilation of the pulmonary autograft after the Ross procedure. J Thorac Cardiovasc Surg 2000; 119: 210220.Google Scholar
18. Isner, JM, Donaldson, RF, Fulton, D, et al. Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites. Circulation 1987; 75: 689695.Google Scholar
19. Niwa, K. Aortic root dilatation in tetralogy of Fallot long-term after repair-histology of the aorta in tetralogy of Fallot: evidence of intrinsic aortopathy. Int J Cardiol 2005; 103: 117119.Google Scholar
20. Rieker, RP, Berman, MA, Stansel, HC. Jr Postoperative studies in patients with tetralogy of Fallot. Ann Thorac Surg 1975; 19: 1726.CrossRefGoogle ScholarPubMed
21. Capelli, H, Ross, D, Somerville, J. Aortic regurgitation in tetrad of Fallot and pulmonary atresia. Am J Cardiol 1982; 49: 19791983.Google Scholar
22. Tan, JL, Davlouros, PA, McCarthy, KP, et al. Intrinsic histological abnormalities of aortic root and ascending aorta in tetralogy of Fallot: evidence of causative mechanism for aortic dilatation and aortopathy. Circulation 2005; 112: 961968.Google Scholar
23. Niwa, K, Siu, SC, Webb, GD, et al. Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation 2002; 106: 13741378.Google Scholar
24. Losay, J, Touchot, A, Capderou, A, et al. Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome. J Am Coll Cardiol 2006; 47: 20572062.Google Scholar
25. Marino, BS, Wernovsky, G, McElhinney, DB, et al. Neo-aortic valvar function after the arterial switch. Cardiol Young 2006; 16: 481489.Google Scholar
26. Takeuchi, T, Imai, Y, Takanashi, Y, et al. Histological study of the great arteries in patients with arterial switch operation. Act Ped Cardiol Jpn 1996; 12: 506512.Google Scholar
27. Schwartz, ML, Gauvreau, K, del Nido, P, et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation 2004; 110: II128132.Google Scholar
28. Cohen, MS, Marino, BS, McElhinney, DB, et al. Neo-aortic root dilation and valve regurgitation up to 21 years after staged reconstruction for hypoplastic left heart syndrome. J Am Coll Cardiol 2003; 42: 533540.Google Scholar
29. Carlo, WF, McKenzie, ED, Slesnick, TC. Root dilation in patients with truncus arteriosus. Congenit Heart Dis 2011; 6: 228233.Google Scholar
30. Egan, M, Phillips, A, Cook, SC. Aortic dissection in the adult Fontan with aortic root enlargement. Pediatr Cardiol 2009; 30: 562563.Google Scholar
31. Carlson, RG, Lillehei, CW, Edwards, JE. Cystic medial necrosis of the ascending aorta in relation to age and hypertension. Am J Cardiol 1970; 25: 411415.Google Scholar
32. Schlatmann, TJ, Becker, AE. Histologic changes in the normal aging aorta: implications for dissecting aortic aneurysm. Am J Cardiol 1977; 39: 1320.Google Scholar
33. Monalo-Estrell, P, Barker, AE. Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol 1967; 83: 336341.Google Scholar
34. Dietz, HC, Pyeritz, RE. Mutations in the human gene for fibrillin-1 (FBN1) in the Marfan syndrome and related disorders. Hum Mol Genet 1995; 4: 17991809.Google Scholar
35. Bonderman, D, Gharehbaghi-Schnell, E, Walleneck, G, et al. Mechanisms underlying aortic dilatation in congenital aortic valve malformations. Circulation 1999; 99: 21382143.Google Scholar
36. Wang, J, Nagy, A, Larsson, J, et al. Defective ALK5 signaling in the neural crest leads to increased postmigratory neural crest cell apoptosis and severe outflow tract defects. BMC Dev Biol 2006; 6: 5164.Google Scholar
37. Schaefer, BM, Lewin, MB, Stout, KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart 2008; 94: 16341638.Google Scholar
38. Jackson, V, Petrini, J, Caidahl, K, et al. Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery. Eur J Cardiothorac Surg 2011; 40: e118124.Google Scholar
39. Chowdhury, UK, Mishra, AK, Balakrishnan, P, et al. Role of fibrillin-1 genetic mutations and polymorphism in aortic dilatation in patients undergoing intracardiac repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2008; 136: 757766.Google Scholar
40. John, AS, McDonald-McGinn, DM, Zackai, EH, et al. Aortic root dilation in patients with 22q11.2 deletion syndrome. Am J Med Genet A 2009; 149A: 939942.CrossRefGoogle ScholarPubMed
41. Cheung, YF, Ou, X, Wong, SJ. Central and peripheral arterial stiffness in patients after surgical repair of tetralogy of Fallot: implications for aortic root dilatation. Heart 2006; 92: 18271830.Google Scholar
42. Murakami, T, Nakazawa, M, Momma, K, et al. Impaired distensibility of neoaorta after arterial switch procedure. Ann Thorac Surg 2000; 70: 19071910.Google Scholar
43. Sievers, HH, Lange, PE, Arensman, FW, et al. Influence of two-stage anatomic correction on size and distensibility of the anatomic pulmonary/functional aortic root in patients with simple transposition of the great arteries. Circulation 1984; 70: 202208.Google Scholar
44. Niwa, K. Aortopathy in congenital heart disease in adults: aortic dilatation with decreased aortic elasticity that impacts negatively on left ventricular function. Korean Circ J 2013; 43: 215220.Google Scholar