DÄ internationalArchive10/2009Management of Patients With Aortic Dissection: New Insights
LNSLNS We think that some aspects of the article should be rectified, and that some additions are required.

Vascular Ehlers-Danlos syndrome (EDS) is not the most common form of EDS since 80–90% of all cases of EDS are “classic” EDS. The categorization of EDS cited by the authors, into 11 forms has been obsolete for 10 years. The authors do not mention Loeys-Dietz syndrome in their review article, which has a rather more aggressive clinical course than Marfan syndrome. Children with this syndrome often have a split uvula and hypertelorism. In patients with such findings, echocardiography should be considered.

We also missed the modalities combining surgery and catheterization (“frozen elephant trunk”) from the spectrum of surgical therapeutic options, which are used to replace the ascending aorta, the aortic arch, and the descending aorta in one session and which usually save the patient from having to undergo a second operation.

Unfortunately the authors do not discuss the importance of the angiotensin II receptor blocker losartan, the most important advance in the long term management of patients with aortic disorders in years. Mouse models have shown that losartan can prevent the development of aortic aneurysms (1), and recently, the New England Journal of Medicine reported positive outcomes for losartan in patients with Marfan syndrome (2).

In the light of these data it seems increasingly questionable whether beta blocker monotherapy reflects the current state of knowledge. With regard to the wide spectrum of readers of the Deutsches Ärzteblatt, we wish to point out these new insights.
DOI: 10.3238/arztebl.2009.0171b


Dr. med. Florian S. Schoenhoff
Proteomics Center
Johns Hopkins University, Baltimore
21224 Maryland USA

PD Dr. sc.nat. Gabor Matyas
Institut für Humangenetik
Universität Zürich
8603 Schwerzenbach, Switzerland

Prof. Dr. med. Thierry Carrel
Klinik für Herz- und Gefäßchirugie
Universitätsspital Bern
3010 Bern, Switzerland
thierry.carrel@insel.ch
1.
Habashi JP, Judge DP, Holm TM et al.: Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 2006; 312: 117–21.
2.
Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC 3rd: Angiotensin II blockade and aortic-root dilation in Marfan's syndrome. N Engl J Med 2008; 358: 2787–95.
3.
Weigang E, Nienaber CA, Rehders TC, Ince H, Vahl C-F, Beyersdorf F: Management of patients with aortic dissection [Management von Patienten mit Aortendissektion]. Dtsch Arztebl Int 2008; 105(38): 639–45.
1. Habashi JP, Judge DP, Holm TM et al.: Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 2006; 312: 117–21.
2. Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC 3rd: Angiotensin II blockade and aortic-root dilation in Marfan's syndrome. N Engl J Med 2008; 358: 2787–95.
3. Weigang E, Nienaber CA, Rehders TC, Ince H, Vahl C-F, Beyersdorf F: Management of patients with aortic dissection [Management von Patienten mit Aortendissektion]. Dtsch Arztebl Int 2008; 105(38): 639–45.