The natural history of type B aortic dissection in patients with PRKG1 mutation c.530G>A (p.Arg177Gln)

• Published in: Journal of vascular surgery 2019-09, Vol.70 (3), p.718-723
• Main Authors: Shalhub, Sherene, MD, MPH, FACS, Regalado, Ellen S., MS, CGC, Guo, Dong-Chuan, PhD, Milewicz, Dianna M., MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - enzymology; Aneurysm, Dissecting - genetics; Aneurysm, Dissecting - therapy; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - enzymology; Aortic Aneurysm, Thoracic - genetics; Aortic Aneurysm, Thoracic - therapy; Cyclic GMP-Dependent Protein Kinase Type I - genetics; DeBakey III aortic dissection; Descending thoracic aortic dissection; Female; Genetic Predisposition to Disease; Heredity; Heritable thoracic aortic disease (HTAD); Humans; Male; Middle Aged; Mutation; Pedigree; Phenotype; PRKG1 mutation; Prognosis; Retrospective Studies; Risk Factors; Surgery; Type B dissection; United States; Young Adult
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2018.12.032

AbstractObjectiveThe c.530G>A (p.Arg177Gln) mutation in PRKG1 has been shown to be associated with thoracic aortic aneurysms and dissections. This rare mutation accounts for an estimated 1% of nonsyndromic heritable thoracic aortic disease. We sought to describe the clinical presentation of type B aortic dissection (TBAD), management, and outcomes in patients with this mutation. MethodsThis is a descriptive multi-institutional retrospective study of patients from six families with the PRKG1 mutation. Patients with TBAD were selected for analysis. Demographics, family histories, TBAD management, and outcomes were reviewed. ResultsOf the 29 individuals diagnosed with the PRKG1 mutation, 12 (41.3%) had TBAD (50% male, TBAD median age: 31 years [range, 16-58 years], median follow-up: 6 years [range, 3-15 years] after TBAD). All had a family history of aortic dissections and none had features of Marfan syndrome. The median size of the descending thoracic aorta (DTA) at TBAD was 4.1 cm (range, 3.8-5 cm). Most cases (9 acute TBAD, 1 incidental TBAD diagnosis during screening) were managed medically. One case had open DTA repair the acute phase. Repair for dissection-related aneurysmal degeneration was performed in seven cases (58.3%) in the chronic phase at a median of 2 years (range, 1-8 years) after TBAD. In four cases (33.3%), the DTA remained stable in size over a range of 1 to 7 years after TBAD. Type A aortic dissection subsequent to TBAD occurred in three cases (25%). There were four (33.3%) deaths in the series, all aortic related at a median age of 24 years (range, 19-43 years). ConclusionsThe PRKG1 (p.Arg177Gln) mutation although rare is associated with nonsyndromic TBAD in young and middle-aged patients. Workup for this gene mutation should be included as part of the workup for TBAD etiology in relatively young patients and those with familial history of aortic dissections. Once diagnosed, testing of first-degree family members is warranted. In all individuals with a PRKG1 mutation, close follow-up for aortic root dilatation and hypertension control is essential to reduce the risk of type A or type B aortic dissection, and in cases of TBAD, to decrease the risk of dissection-related aneurysmal degeneration.