Description:

Aortic dilation is common in patients with congenital heart disease including those with a bicuspid aortic valve, connective tissue disease, coarctation of the aorta, and conotruncal defects. In addition, neo-aortic dilation has been described in patients after aortic reconstruction including the Norwood procedure, the arterial switch operation, and the Ross procedure. Although aortic catastrophe is rare in patients with congenital heart disease, common pathologic endpoints in these patients likely manifest with similar aortic tissue behaviour. A lifelong care model with similar indications for surveillance and prophylactic repair to other more common aortic diseases is therefore warranted. Still, reoperative aortic arch reconstruction in these patients is often a complex endeavour, and in all cases, a tailored and adaptable plan ensuring adequate myocardial and cerebral protection with appropriate rescue measures is paramount. A surgical team taking on these challenging cases should possess an armamentarium of open, hybrid, and endovascular techniques which can be individualized to a patient's unique anatomy, surgical history, and concomitant lesions as well as the team's measured outcomes and experience.

Transcatheter aortic valve replacement has emerged as a safe and effective alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis across the spectrum of surgical risks based on a series of foundational randomized clinical trials. Of note, patients with Bicuspid Aortic Valve (BAV) disease were excluded from all these pivotal randomized trials, leaving a significant knowledge gap because BAVs are commonly encountered in patients referred for aortic valve surgery or intervention. In this comprehensive review, we aim to provide heart teams with a detailed insight into how to approach patients with BAV disease, focusing on imaging and characterization of bicuspid valves, an overview of surgical approaches, and an understanding of the current data behind the role of transcatheter aortic valve replacement for patients with BAV disease. Aortic diseases, mainly including aortic dilatation, Aortic Aneurysm (AA) and Aortic Dissection (AD), have high morbidity and mortality. Many studies have suggested that Obstructive Sleep Apnea (OSA) acts as a candidate risk factor for aortic diseases. Thus, we performed a meta-analysis to explore comprehensively the effect of OSA on the risk of aortic disease occurrence.

Heart valve disease is common and becomes increasingly prevalent with advancing age. Increasing life expectancy means an increased demand on healthcare services worldwide. Aortic valve disease includes aortic stenosis and aortic regurgitation. Aortic stenosis is the most prevalent valve disorder and in the geographical west is most commonly caused by degenerative calcification. Rheumatic heart disease is a common cause of aortic stenosis in developing countries. Once patients develop symptoms of angina, presyncope, syncope or dyspnoea, the prognosis is poor without treatment. Long-term sequelae in untreated patients include heart failure and death. Echocardiography is central to the assessment of valve morphology, severity and consequences for left ventricular function, and remains the gold standard investigative tool. Aortic valve replacement or transcatheter aortic valve implantation improves survival rates. The choice of valve intervention should be decided upon by the heart valve team on a case-by-case basis.

With Regards
 Augas
Journal Coordinator
Global Journal of Research and Review