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Buja LM, Zhao B, Vela D, Segura A, Narula N. Pathobiology of Aortic Aneurysms and Dissections: Synthesis of Recent Investigations and Evolving Insights. JACC. ADVANCES 2025; 4:101682. [PMID: 40286354 PMCID: PMC12101538 DOI: 10.1016/j.jacadv.2025.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 02/24/2025] [Accepted: 02/25/2025] [Indexed: 04/29/2025]
Abstract
The pathobiology of aortic disease is linked to aortic region: atherosclerosis for abdominal aorta, primary medial degeneration or aortitis for ascending thoracic aorta, and all causes for descending thoracic aorta and thoracoabdominal lesions. The pathogenesis of aortic dissection involves damage of the outer media from impaired perfusion from dysfunctional vasa vasorum, formation of discrete foci of disrupted vascular smooth muscle cell-elastic fiber extension-contractile units, and imbalance of radial sheer stress across the aortic wall, thereby creating an intimal tear and linear dissection. Thoracic aortic aneurysms develop from the chronic progression of medial degeneration coupled with the weakening of the remodeled adventitia, allowing for aortic dilatation. Precipitating factors include hypertension and mutations of genes regulating the vascular smooth muscle cell-elastic fiber extension-contractile units. Criteria are presented for distinguishing genetic from acquired causes of thoracic aortic aneurysms and dissections, with important implications for therapeutic and surgical decisions in the care of these patients.
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Affiliation(s)
- L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth-Houston), Houston, Texas, USA; Cardiovascular Pathology Research Department, The Texas Heart Institute, Baylor St. Luke's Hospital, Houston, Texas, USA.
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth-Houston), Houston, Texas, USA
| | - Deborah Vela
- Cardiovascular Pathology Research Department, The Texas Heart Institute, Baylor St. Luke's Hospital, Houston, Texas, USA
| | - Ana Segura
- Cardiovascular Pathology Research Department, The Texas Heart Institute, Baylor St. Luke's Hospital, Houston, Texas, USA
| | - Navneet Narula
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth-Houston), Houston, Texas, USA
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Elendu C, Nzeako TR, Nwachukwu NO, Akpa KN, Omiko RA, Ayobami-Ojo PS, Orji UW, Nwankwo VC, Amaefule KC, Chima CS, Chika NW, Olukorode JO, Oloyede PO, Falade DM, Fayemi TE, Ezeamaku-Humphrey CP, Vansh RR, Enaholo TMO, Anukam LI, Chukwuneke OM. Genetic factors and management strategies in aortic health: a literature review of inherited aortopathy. Ann Med Surg (Lond) 2025; 87:598-615. [PMID: 40110250 PMCID: PMC11918753 DOI: 10.1097/ms9.0000000000002969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 01/11/2025] [Indexed: 03/22/2025] Open
Abstract
Inherited aortopathies, including Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome, are genetic disorders characterized by structural abnormalities of the aorta that predispose individuals to life-threatening complications like aneurysms and dissections. These conditions result from mutations in genes essential for maintaining aortic wall integrity, such as FBN1, TGFBR1, and COL3A1, affecting extracellular matrix components and the transforming growth factor-beta (TGF-β) pathway. Marfan syndrome has a prevalence of approximately 1 in 5000, while Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome are rarer, with estimated prevalences of 1 in 100 000 and 1 in 20 000, respectively. Familial thoracic aortic aneurysms and dissections (FTAAD), linked to mutations in genes like ACTA2 and MYH11, highlight the genetic heterogeneity of aortopathies. Management strategies focus on early diagnosis, risk stratification, regular imaging, lifestyle modifications, and timely surgical intervention. Advances in genetic testing and targeted therapies offer promise for personalized care. However, challenges such as genetic heterogeneity, incomplete penetrance, and variability in disease progression limit effective management. Limitations in current research include heterogeneity among studies, which complicates meta-analyses and consensus building. Future directions include exploring novel genetic interventions, optimizing treatment timing, and addressing psychosocial impacts to enhance patient outcomes. By addressing gaps in knowledge and integrating patient-reported outcomes, this study underscores the importance of a multidisciplinary approach to managing inherited aortopathies and improving the quality of life for affected individuals.
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Affiliation(s)
- Chukwuka Elendu
- Federal University Teaching Hospital, Kenneth N. Akpa, Owerri, Nigeria
| | | | | | | | | | | | | | - Vivian C Nwankwo
- Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | | | | | - Nwafor W Chika
- Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | | | | | - David M Falade
- Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | | | | | | | | | - Lordsfavour I Anukam
- International University of the Health Sciences, Basseterre, Saint Kitts and Nevis
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Salzillo C, Marzullo A. Hereditary Aortopathies as Cause of Sudden Cardiac Death in the Young: State-of-the-Art Review in Molecular Medicine. Diseases 2024; 12:264. [PMID: 39589938 PMCID: PMC11592702 DOI: 10.3390/diseases12110264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/06/2024] [Accepted: 10/20/2024] [Indexed: 11/28/2024] Open
Abstract
Hereditary aortopathies are a group of rare genetic diseases affecting the aorta and its major branches, and they represent a cause of sudden cardiac death. These pathologies are classified into syndromic hereditary aortopathies and non-syndromic hereditary aortopathies. The epidemiology of hereditary aortopathies varies according to the specific genetic condition involved; however, these disorders are believed to account for a significant proportion of sudden cardiac death in young individuals with a family history of inherited cardiovascular conditions. The causes of hereditary aortopathies are primarily genetic, with pathogenic variants in various genes encoding structural proteins of the vascular wall, leading to dissection, aneurysms, rupture, and ultimately sudden cardiac death. When the cause of death remains unknown after an autopsy, it is referred to as sudden unexplained death, and post-mortem genetic testing, known as a molecular autopsy, is crucial to confirm hereditary aortopathies and assess the genetic risk in the patient's relatives. This helps to facilitate diagnostic and therapeutic pathways and/or implement monitoring strategies to prevent sudden cardiac death. In this state-of-the-art review, we focus on syndromic and non-syndromic hereditary aortopathies causing sudden cardiac death in the young and explore preventive strategies for affected family members.
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Affiliation(s)
- Cecilia Salzillo
- Department of Experimental Medicine, PhD Course in Public Health, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pathology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Andrea Marzullo
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Pathology, University of Bari “Aldo Moro”, 70121 Bari, Italy
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Elefteriades JA, Zafar MA, Ziganshin BA. Genetics of aortic aneurysm disease: 10 key points for the practitioner. JTCVS OPEN 2024; 21:58-63. [PMID: 39534337 PMCID: PMC11551243 DOI: 10.1016/j.xjon.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/27/2024] [Accepted: 07/16/2024] [Indexed: 11/16/2024]
Affiliation(s)
- John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Mohammad A. Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
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Eisenberg SD, Thompson KM, Naeem M, Weintraub NL, Leshnower BG, Abunimer AN, Winkler MA. Maffucci Syndrome May Be a Heritable Thoracic Aortic Disease and a Cause of Aortic Dissection. JACC Case Rep 2024; 29:102496. [PMID: 39359503 PMCID: PMC11442171 DOI: 10.1016/j.jaccas.2024.102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/10/2024] [Accepted: 07/08/2024] [Indexed: 10/04/2024]
Abstract
A woman with Maffucci syndrome (MS) presented post partum with type B aortic dissection leading to rupture of a thoracoabdominal aneurysm. Results of multiple-gene testing for heritable thoracic aortic disease were negative. Although conjectural, this patient's aortic disease may be related to MS, and surveillance for aortic disease in patients with MS may be appropriate.
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Affiliation(s)
- Scott D Eisenberg
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim M Thompson
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Muhammad Naeem
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neal L Weintraub
- Division of Cardiovascular Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ayman N Abunimer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael A Winkler
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Alhatemi AQM, Aziz EMH, Al-Yaseen AHA, Hashim HT, Abduljabbar ZH, Sultan SQ, Abdulhussain TK, Abdulhussain R. Aortic Aneurysm Mimicking Inferior ST-Elevation Myocardial Infarction: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096241264634. [PMID: 39044567 PMCID: PMC11268006 DOI: 10.1177/23247096241264634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 07/25/2024] Open
Abstract
Here, we report a rare case of a 22-year-old female presenting with recurrent chest pain mimicking inferior ST-elevation myocardial infarction (STEMI) but ultimately attributed to an aortic aneurysm. Despite facing initial challenges in diagnosis, such as normal troponin levels and temporary electrocardiogram (ECG) changes, advanced imaging showed a large mass in the chest pressing on the right coronary artery. Prompt multidisciplinary intervention, including surgical resection of the aneurysm, led to successful management and improved outcomes. This case highlights the importance of considering unusual etiologies in atypical presentations of myocardial infarction, necessitating comprehensive evaluation and collaboration among various specialties for optimal patient care.
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