Progression of Aortic Dilatation and the Benefit of Long-Term β-Adrenergic Blockade in Marfan's Syndrome

Shores, J.; Berger, Kenneth R.; Murphy, Edmond A.; Pyeritz, Reed E.

doi:10.1056/nejm199405123301902

Cited by 1,004 publications

(567 citation statements)

References 35 publications

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“…Beta adrenergic-blocking drugs should be administered to all patients with Marfan syndrome and aortic aneurysm to reduce the rate of aortic dilatation unless contraindicated. 101 (Level of Evidence: B)…”

Section: Recommendations For Blood Pressure Controlmentioning

confidence: 99%

“…For patients with thoracic aortic aneurysm, it is reasonable to reduce blood pressure with beta blockers and angiotensin-converting enzyme inhibitors 103 or angiotensin receptor blockers 104,105 to the lowest point patients can tolerate without adverse effects. [100][101][102] (Level of Evidence: B) 2. An angiotensin receptor blocker (losartan) is reason able for patients with Marfan syndrome, to reduce the rate of aortic dilatation unless contraindicated.…”

Section: Class Iiamentioning

confidence: 99%

See 1 more Smart Citation

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Hiratzka

Bakris

Beckman

et al. 2010

Cathet Cardio Intervent

280

105

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Section: Recommendations For Blood Pressure Controlmentioning

confidence: 99%

Section: Class Iiamentioning

confidence: 99%

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Hiratzka

Bakris

Beckman

et al. 2010

Cathet Cardio Intervent

280

105

View full text Add to dashboard Cite

“…Previous studies have shown the efficacy of β-blockers in retarding the rate of aortic dilatation, decreasing adverse end points (aortic dissection, chronic heart failure), and decreasing mortality. 80,81 Although these studies specifically evaluated patients with Marfan syndrome, logic would argue that aggressive hypertension management would be beneficial to all patients with TAA to reduce dP/dt and systemic arterial blood pressure. In addition, because TAA is closely linked to atherosclerotic disease, outpatient medical management must also include aggressive lipid management with a goal low-density lipoprotein cholesterol level of less than 70 mg/dL (to convert to mmol/L, multiply by 0.0259).…”

Section: Thoracic Aortic Aneurysmsmentioning

confidence: 99%

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Ramanath

Sundt

et al. 2009

Mayo Clinic Proceedings

196

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Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. and studied by physicians for centuries. Descriptions of such pathologic conditions of the aorta as aneurysm and dissection date back as early as the 2nd century during the time of Galen, whose discoveries were largely made through studies of apes. More "recent" reports were described by Vesalius in 1557, followed by Nichols in 1732, who detailed the process of aortic dissection. In 1761, Morgagni reported detailed pathologic features of a patient with a ruptured aorta. 1 However, our true understanding of aortic pathology began with the dissertation by Shennan 2 in 1934, which included a description of penetrating atheromatous plaques of the thoracic aorta. His report was followed by the first successful management of aortic dissection by DeBakey in 1955. 1 Since then, our knowledge of the pathologic conditions of the aorta has grown considerably and continues to evolve with ongoing research into the pathophysiology of these conditions, technological advances in the modes of detection, and improved therapeutic options. Clinical databases, such as the International Registry of Acute Aortic Dissection (IRAD), the largest current registry for acute aortic syndromes, have also contributed tremendously to our knowledge of acute aortic pathology.For the practicing clinician, knowledge of aortic disease is paramount because patients with aortic conditions contribute significantly to the overall mortality from cardiovascular disease. This review discusses the pathophysiology, epidemiology, presentation, diagnosis, and therapeutic options for several forms of acute and chronic aortic pathology: aortic dissection (including its variants intramural hematoma [IMH] and penetrating atheromatous aortic ulcer) and thoracic aortic aneurysm (TAA). Literature searches were performed of the PubMed database using the following key words: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies conducted within the past 15 years, along with some data from years prior, were included in this review.

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“…The complication of Stanford type B dissection can also develop before and during delivery, however, it rare for this to develop after delivery (3,4,6,12 (11,16,17). Controversy exists regarding the teratogenic effects of β-blockers in the peripartum period.…”

Section: F I G U R E 4 A) Mu L T I P L a N A R R E F O R Ma T T E Dmentioning

confidence: 99%

“…Controversy exists regarding the teratogenic effects of β-blockers in the peripartum period. Some studies show that β-blockers are not teratogenic (18), and others mention that even long-term treatment with β-blockers is safe (16,19). According to these reports, the use of β-blockers is recommended during pregnancy in Marfan's syndrome (10,11,17,20).…”

Section: F I G U R E 4 A) Mu L T I P L a N A R R E F O R Ma T T E Dmentioning

confidence: 99%

Risk of Development of Abdominal Aortic Aneurysm and Dissection of Thoracic Aorta in a Postpartum Womanwith Marfans Syndrome

et al. 2006

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Progression of Aortic Dilatation and the Benefit of Long-Term β-Adrenergic Blockade in Marfan's Syndrome

Abstract: Prophylactic beta-adrenergic blockade is effective in slowing the rate of aortic dilatation and reducing the development of aortic complications in some patients with Marfan's syndrome.

Cited by 1,004 publications

References 35 publications

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Risk of Development of Abdominal Aortic Aneurysm and Dissection of Thoracic Aorta in a Postpartum Womanwith Marfans Syndrome

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