EFFECT OF AORTIC STIFFNESS PARAMETERS BY CARDIAC MAGNETIC RESONANCE ON AORTIC DILATION IN PATIENTS WITH BICUSPID AORTIC VALVE

Abstract Background Aortic stiffness has been shown to be abnormal in patients with bicuspid aortic valve (BAV), and is considered a component of the aortopathy associated with this condition. Progressive aortic stiffening associated with aging has been previously described in normal adults. However, it is not known if aging related aortic stiffening occurs at the same rate in BAV patients. We determined the longitudinal rate of decline in segmental distensibility in BAV patients using serial cardiovascular magnetic resonance (CMR) studies, and compared to previously published results from a group of patients with connective tissue disorders (CTD). Methods A retrospective review of CMR and clinical data on children and adults with BAV (n = 49, 73% male; 23 ± 11 years) with at least two CMRs (total 98 examinations) over a median follow-up of 4.1 years (range 1–9 years) was performed to measure aortic distensibility at the ascending (AAo) and descending aorta (DAo). Longitudinal changes in aortic stiffness were assessed using linear mixed-effects modeling. The comparison group of CTD patients had a similar age and gender profile (n = 50, 64% male; 20.6 ± 12 years). Results Compared to CTD patients, BAV patients had a more distensible AAo early in life but showed a steeper decline in distensibility on serial examinations [mean 10-year decline in AAo distensibility (× 10−3 mmHg−1) 2.4 in BAV vs 1.3 in CTD, p = 0.005]. In contrast, the DAo was more distensible in BAV patients throughout the age spectrum, and DAo distensibility declined with aging at a rate similar to CTD patients [mean 10 year decline in DAo distensibility (× 10−3 mmHg−1) 0.3 in BAV vs 0.4 in CTD, p = 0.58]. Conclusions On serial CMR measurements, AAo distensibility declined at significantly steeper rate in BAV patients compared to a comparison group with CTDs, while DAo distensibility declined at similar rates in both groups. These findings offer new mechanistic insights into the differing pathogenesis of the aortopathy seen in BAV and CTD patients.

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The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance

10.21203/rs.3.rs-62852/v1 ◽

2020 ◽

Author(s):

Marek Jasinski ◽

Karol Miszalski-Jamka ◽

Radoslaw Gocol ◽

Izabella Wenzel-Jasinska ◽

Grzegorz Bielicki ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Aortic Valve Area ◽

Valve Repair ◽

Valve Area

Abstract Background: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodeling using cardiac magnetic resonance (CMR) and compare the mid-term results of external and subcommissural annuloplasty. Methods: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period. CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r=0.62; p=0.003) as well as left ventricular ejection fraction (r=-0.53; p=0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5cm2 (2.5; 4.0) vs. 2.5cm2 (2.0; 3.4); p=0.04). In both EA and SCA group, aortic valve area below 3.5cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10mmHg (6; 17) vs. 21mmHg (15; 27); p=0.04). Conclusions: The repair of the bicuspid aortic valve provides significant mid-term postoperative reverse remodeling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. External, circumferential annuloplasty is associated with better hemodynamics compared to subcommissural annuloplasty.

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Diverticulum, or not Diverticulum, That Is the Question! Discussing About a Case of Left Ventricular Outpouching Associated With Bicuspid Aortic Valve Assessed by Cardiac Magnetic Resonance

Journal of Cardiovascular and Thoracic Research ◽

10.15171/jcvtr.2015.16 ◽

2015 ◽

Vol 7 (2) ◽

pp. 72-74 ◽

Cited By ~ 2

Author(s):

Raffaella Capasso ◽

Maria Panelo ◽

Andrea Fiorelli ◽

Iacopo Carbone ◽

Nicola Galea

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Left Ventricular

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Abnormal aortic stiffness in patients with bicuspid aortic valve: phenotypic variation determined by magnetic resonance imaging

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-018-1433-y ◽

2018 ◽

Vol 35 (1) ◽

pp. 133-141 ◽

Cited By ~ 4

Author(s):

Thananya Boonyasirinant ◽

Prabhakar Rajiah ◽

Scott D. Flamm

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Phenotypic Variation ◽

Aortic Stiffness ◽

Resonance Imaging

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Abnormalities of the major intrathoracic arteries in Turner syndrome as revealed by magnetic resonance imaging

Cardiology in the Young ◽

10.1017/s1047951110000041 ◽

2010 ◽

Vol 20 (2) ◽

pp. 191-200 ◽

Cited By ~ 46

Author(s):

Kristian Havmand Mortensen ◽

Britta Eilersen Hjerrild ◽

Niels Holmark Andersen ◽

Keld Ejvind Sørensen ◽

Arne Hørlyck ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Aortic Valve ◽

Head And Neck ◽

Aortic Arch ◽

Turner Syndrome ◽

Bicuspid Aortic Valve ◽

Aortic Coarctation ◽

Resonance Imaging ◽

Aortic Dilation

AbstractBackgroundEctatic aortopathy and arterial abnormalities cause excess morbidity and mortality in Turner syndrome, where a state of vasculopathy seemingly extends into the major head and neck branch arteries.ObjectiveWe investigated the prevalence of abnormalities of the major intrathoracic arteries, their interaction with arterial dimensions, and their association with karyotype.DesignMagnetic resonance imaging scans determined the arterial abnormalities as well as head and neck branch artery and aortic dimensions in 99 adult women with Turner syndrome compared with 33 healthy female controls. Echocardiography determined aortic valve morphology.ResultsIn Turner syndrome, the relative risk of any congenital abnormality was 7.7 (p = 0.003) and 6.7 of ascending aortic dilation (p = 0.02). A bovine aortic arch was seen in both Turner syndrome and controls. Other abnormalities were only encountered in Turner syndrome: elongated transverse aortic arch (47%), bicuspid aortic valve (27%), aortic coarctation (13%), aberrant right subclavian artery (8%), and aortic arch hypoplasia (2%). The innominate and left common carotid arteries were enlarged in Turner syndrome (p < 0.001). Significant associations were first, bicuspid aortic valve with aortic coarctation, elongated transverse aortic arch, and ascending aortic dilation; second, aortic coarctation with elongated aortic arch and descending aortic dilation; third, 45,X with aortic coarctation, elongated transverse aortic arch and ascending aortic dilation; and fourth, branch artery dilation with bicuspid aortic valve, aortic coarctation, elongated transverse aortic arch and 45,X.ConclusionAn increased risk of arterial abnormalities, aortic dilation, and enlargement of the branch arteries was found in Turner syndrome without distinct patterns of co-segregation.

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The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance

10.21203/rs.3.rs-62852/v2 ◽

2020 ◽

Author(s):

Marek Jasinski ◽

Karol Miszalski-Jamka ◽

Kinga Kosiorowska ◽

Radoslaw Gocol ◽

Izabella Wenzel-Jasinska ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Aortic Valve Area ◽

Valve Repair ◽

Reverse Remodelling ◽

Valve Area

Abstract Background: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodelling using cardiac magnetic resonance (CMR) and compare the results of external and subcommissural annuloplasty. Methods: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period (median: 12.6 months (first quartile: 6.6; third quartile: 14.1). CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r = 0.62; p = 0.003) as well as left ventricular ejection fraction (r = -0.53; p = 0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5 (2.5; 4.0) vs. 2.5 cm2 (2.0; 3.4); p = 0.04). In both EA and SCA group, aortic valve area below 3.5 cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10 (6; 17) vs. 21mmHg (15; 27); p = 0.04). Conclusions: The repair of the bicuspid aortic valve provides significant postoperative reverse remodelling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. EA is associated with lower transvalvular gradients and higher aortic valve area assessed by CMR, compared to SCA.

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