Therapies for Thoracic Aortic Aneurysms and Acute Aortic Dissections: Old Controversies and New Opportunities

The medical therapies for thoracic aortic aneurysm comprise of β-adrenergic blocking agents and angiotensin II type I receptor. Several large randomized trials of pediatric and adult patients with Marfan syndrome have yielded no evidence that antagonism of angiotensin II type I receptor by losartan slows aortic enlargement more effectively than conventional treatment with β-blockers. Studies in mouse models have begun to resolve the complex molecular pathophysiology underlying onset and progression of aortic disease and have emphasized the need to preserve the transformation growth factor-β signaling to prevent aneurysm formation.
This review describes critical experiments that have influenced the evolution of our understanding of thoracic aortic disease, in addition to discussing old controversies and identifying new therapeutic opportunities.