Publication: Modelo experimental de aneurisma de la arteria aorta ascendente: estudio de los factores reológicos
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2019-01-30
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Universidad Complutense de Madrid
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Abstract
La estenosis valvular aórtica es la valvulopatía adquirida más frecuente pudiendo afectar hasta a un 4% de la población de edad avanzada. El desarrollo de dilatación de la aorta ascendente asociada a la estenosis valvular aórtica es más frecuente en este grupo de pacientes; sin embargo, no existe una clara relación entre gradiente transvalvular y dilatación aórtica.La válvula aórtica bicúspide (VAB) es la cardiopatía congénita más frecuente en la población general y afecta al 1-2 % de dicha población. Se asocia también a aneurismas torácicos. Se estima que hasta un 80% de los pacientes afectos de VAB desarrollarán dilatación de aorta ascendente a lo largo de su vida, así como importantes complicaciones cardiovasculares, destacando un aumento de hasta 9 veces el riesgo de presentar disección de aorta. Existe gran controversia en la patogénesis de la alteración proximal de la aorta ascendente. En la actualidad se postulan dos teorías que intentan explicar la aortopatía de la VAB: “la genética” y “la reológica”. La teoría genética implica la presencia de un defecto genético subyacente, que justifica tanto la valvulopatía como la aortopatía. En la “teoría reológica” se postula que el estrés mecánico, secundario a las anomalías hemodinámicas sobre la pared aórtica como consecuencia del flujo excéntrico y turbulento en la VAB, produce la subsecuente dilatación aneurismática de la aorta ascendente...
Aortic valve stenosis is the commonest heart valve disease, affecting up to 4% of the elderly population. Although aortic root dilatation occurs frequently, it does not seem to be related to the severity of the stenosis. Bicuspid aortic valve (BAV), which is the commonest congenital heart disorder with a prevalence of 1–2%, is more frequently associated with an ascending aortic aneurysm. It is estimated that up to 80% of patients with BAV develop some degree of aortic dilatation during their lifetimes, as well as important clinical sequela, including a nine-fold increase of aortic dissection.Two main theories have been proposed to explain the high incidence of aortopathy in BAV disease: the genetic theory, whereby the presence of aortic wall fragility is a con-sequence of a common developmental defect involving the aortic valve and the aortic wall; and the rheological theory, whereby the abnormal haemodynamic stress on the aortic wall that is induced by an eccentric turbulent flow through the BAV leads to aor-topathy. HYPOTHESIS AND OBJECTIVES The hypothesis of this doctoral thesis is that rheological factors caused by altered aortic valve are sufficient to induce ascending aortic aneurysms. To demonstrate this hypothesis we developed a large animal model (pig)with asymmetric supravalvular aortic stenosis that induces eccentric flow. This model underwent longitudinal follow up using cardiovascular magnetic resonance imaging (MRI) and finally aortic wall samples were analysed looking for secondary histological changes...
Aortic valve stenosis is the commonest heart valve disease, affecting up to 4% of the elderly population. Although aortic root dilatation occurs frequently, it does not seem to be related to the severity of the stenosis. Bicuspid aortic valve (BAV), which is the commonest congenital heart disorder with a prevalence of 1–2%, is more frequently associated with an ascending aortic aneurysm. It is estimated that up to 80% of patients with BAV develop some degree of aortic dilatation during their lifetimes, as well as important clinical sequela, including a nine-fold increase of aortic dissection.Two main theories have been proposed to explain the high incidence of aortopathy in BAV disease: the genetic theory, whereby the presence of aortic wall fragility is a con-sequence of a common developmental defect involving the aortic valve and the aortic wall; and the rheological theory, whereby the abnormal haemodynamic stress on the aortic wall that is induced by an eccentric turbulent flow through the BAV leads to aor-topathy. HYPOTHESIS AND OBJECTIVES The hypothesis of this doctoral thesis is that rheological factors caused by altered aortic valve are sufficient to induce ascending aortic aneurysms. To demonstrate this hypothesis we developed a large animal model (pig)with asymmetric supravalvular aortic stenosis that induces eccentric flow. This model underwent longitudinal follow up using cardiovascular magnetic resonance imaging (MRI) and finally aortic wall samples were analysed looking for secondary histological changes...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 05-07-2018