scholarly journals 520Thoracic aorta flow by 4D flow CMR is altered in patients presenting partial fusion of two aortic valve leaflets

2019 ◽  
Vol 20 (Supplement_2) ◽  
Author(s):  
A Guala ◽  
L Galian ◽  
G Teixido Tura ◽  
A Ruiz Munoz ◽  
C Granato ◽  
...  
Keyword(s):  
Aortic Valve ◽  
4D Flow ◽  
4D Flow Cmr ◽  
Aortic Valve Leaflets ◽  
Partial Fusion

477Partial fusion of two aortic valve leaflets is related to alterations in ascending aorta flow: 4D flow CMR study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Guala ◽  
L Galian ◽  
G Teixido Tura ◽  
L Dux-Santoy ◽  
A Ruiz Munoz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Ascending Aorta ◽  
Aortic Dilation ◽  
4D Flow ◽  
4D Flow Cmr ◽  
Flow Displacement ◽  
Aortic Valve Leaflets ◽  
Partial Fusion ◽  
Cine Cmr

Abstract Introduction Bicuspid aortic valve (BAV) is the most common congenital valve defect. It consists in the fusion of two aortic valve leaflets, and it is associated with a high prevalence of proximal aorta dilation. Dilation is highly prevalent (around 30%) in BAV patient relatives with a tricuspid valve (TAV) identified by echocardiography. However, the presence of partial aortic valve leaflet fusion (also called mini-raphe or forme fruste BAV, see figure 1A) is easily missed by echocardiography. A recent study reported that 44% of patients from a small cohort of BAV patient relatives with aortic dilation followed by CT showed mini-raphe. Purpose We aimed to use 4D flow CMR to assess if the presence of mini-raphe is associated with aortic flow alterations, which may be concurs in the etiology of aortic dilation in BAV patient relatives. Methods Twenty BAV patients first-degree relatives with partial fusion (<50%) of aortic valve leaflets and proximal aorta dilation were identified by CT or cine CMR and prospectively included. One-hundred twenty-five BAV and 95 patients with TAV from our prospective dataset of 4D flow CMR were included for comparison. Propensity score matching was used throughout the study to correct the comparisons between mini-raphe and BAV and mini-raphe and TAV patients for differences in age, maximum aortic diameter, sex, height, weight, proximal aortic pulse wave velocity and, only for BAV, fusion pattern. The hemodynamic parameters previously related to aortic dilation were computed. They were jet angle, normalized flow displacement and systolic flow reversal ratio (SFRR, identifying through-plane vortexes) were computed and compared in the ascending aorta and in the aortic arch. Results The presence of mini-raphe was statistically-significantly associated with increase in jet angle (Figure 1B), flow displacement (Figure 1C) and vortexes (Figure 1D) in most of the ascending aorta and aortic arch when mini-raphe patients were compared with TAV patients. The severity of flow asymmetry found in mini-raphe patients was lower than the one characteristic of BAV patients, but vortexes were even higher in a small region at the distal ascending aorta. Figure 1 Conclusion Partial fusion of the aortic valve leaflets is related to increase in proximal aorta flow eccentricity and vorticity. These flow abnormalities are not as marked as those associated with BAV. Data regarding prevalence of mini-raphe as evaluated with CT or cine CMR are needed, especially in familiar of BAV patients. Acknowledgement/Funding European FP7/People 267128; Spanish Ministry of Economy and Competitiveness RTC-2016-5152-1 and Instituto de Salud Carlos III PI14/0106

scholarly journals CMR 4D flow underestimates peak systolic flow measurements in patients with severe aortic stenosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Halva ◽  
J Peltonen ◽  
T Kaasalainen ◽  
J Lommi ◽  
S Suihko ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Peak Flow ◽  
Aortic Valve Area ◽  
Limits Of Agreement ◽  
4D Flow ◽  
Flow Measurements ◽  
4D Flow Cmr ◽  
2D Flow ◽  
The Difference

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Helsinki University Hospital, Finland Background Aortic stenosis (AS) is the most prevalent valvular disease in the developed countries. 4D flow is an emerging cardiac magnetic resonance (CMR) imaging technique, which has been suggested to improve the evaluation of AS severity. The accuracy of peak flow measurement by 4D flow CMR in patients with severe AS has, however, remained unvalidated. Purpose We investigated the reliability of the novel 4D flow CMR technique in measuring transvalvular peak systolic flow in patients with severe aortic valve stenosis. Methods The study included 63 patients clinically evaluated for valve replacement due to severe symptomatic AS. All the patients underwent echocardiography, 2D phase-contrast and 4D flow CMR. CMR was performed on consecutive patients according to international guidelines. Mean age of the patients was 73.8 ± 11.5 years, mean aortic valve area 0.7 ± 0.2 cm², and 40 of the valves were tricuspid and 23 bicuspid. QFlow and QFlow 4D software were used for flow analyses. Bland-Altman analyses and Wilcoxon signed rank sum tests were performed using SPSS software. Results CMR 4D flow analyses underestimated peak flow values when compared with echocardiography (bias -1.1 m/s, limits of agreement ± 1.5 m/s) and with 2D flow analyses (bias -1.2 m/s, limits of agreement ± 1.7 m/s). The difference between values obtained by 4D flow (median 3.1 m/s, range 1.5 – 4.9 m/s) and echocardiography (median 4.3 m/s, range 2.1 – 6.1 m/s) as well as by 2D flow (median 4.3 m/s, range 2.0 – 8.4 m/s) were statistically significant (p &lt; 0,001). The difference between 2D flow analyses and echocardiography remained statistically insignificant (bias 0.05 m/s, limits of agreement ± 1.6 m/s). Conclusions We found that 4D flow analysis significantly underestimates systolic peak flow values in patients with severe AS. This may be due to intra-voxel averaging of the narrow jets. In contrast to previous assumptions, traditional 2D flow technique may therefore outperform 4D flow in measuring valvular peak flow by CMR in patients with severe AS. This should be taken into consideration when assessing disease severity by CMR. Abstract Figure. Peak systolic flow in AS patients (n = 63)

scholarly journals Applications of a Specialty Bicuspid Aortic Valve Program: Clinical Continuity and Translational Collaboration

2020 ◽  
Vol 9 (5) ◽  
pp. 1354
Author(s):  
Erin E. Crawford ◽  
Patrick M. McCarthy ◽  
S. Chris Malaisrie ◽  
Jyothy J. Puthumana ◽  
Joshua D. Robinson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Biomarker Discovery ◽  
Elective Surgery ◽  
Prophylactic Surgery ◽  
Medical Patients ◽  
4D Flow ◽  
Clinical Registry ◽  
Tissue Samples ◽  
4D Flow Cmr

Bicuspid aortic valve (BAV) is a common congenital heart diagnosis and is associated with aortopathy. Current guidelines for aortic resection have been validated but are based on aortic diameter, which is insufficient to predict acute aortic events. Clinical and translational collaboration is necessary to identify biomarkers that can individualize the timing of prophylactic surgery for BAV aortopathy. We describe our multidisciplinary BAV program, including research protocols aimed at biomarker discovery and results from our longitudinal clinical registry. From 2012–2018, 887 patients enrolled in our clinical BAV registry with the option to undergo four dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) and donate serum plasma or tissue samples. Of 887 patients, 388 (44%) had an elective BAV-related procedure after initial presentation, while 499 (56%) continued with medical management. Of medical patients, 44 (9%) had elective surgery after 2.3 ± 1.4 years. Surgery patients’ biobank donations include 198 (46%) aorta, 374 (86%) aortic valve, and 314 (73%) plasma samples. The 4D flow CMR was completed for 215 (50%) surgery patients and 243 (49%) medical patients. Patients with BAV aortopathy can be safely followed by a multidisciplinary team to detect indications for surgery. Paired tissue and hemodynamic analysis holds opportunity for biomarker development in BAV aortopathy.

The length of the fusion between leaflets in bicuspid aortic valve is independently related to ascending aorta dilation and flow dynamics alterations assessed by 4D-flow CMR

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Guala ◽  
A Evangelista ◽  
L La Mura ◽  
G Teixido-Tura ◽  
L Dux-Santoy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Statistical Significance ◽  
Ascending Aorta ◽  
Funding Source ◽  
Aortic Dilation ◽  
4D Flow ◽  
National Budget ◽  
4D Flow Cmr ◽  
Aortic Replacement

Abstract Background Aortic dilation in bicuspid aortic valve (BAV) patients has been related to altered flow patterns, which contribute to aortic wall degeneration. However, preventive aortic replacement is currently based on a diameter threshold. Several studies on excised BAV reported wide variability of fusion extent. Purpose To unveil whether leaflet fusion extent can be quantified by CMR and is related to aortic dilation and flow abnormalities in non-dysfunctional BAV. Methods One hundred and twenty adults with non-dysfunctional BAV and no previous aortic or aortic valve surgery and 28 healthy volunteers underwent double-oblique cine and 4D flow CMR. BAV patients with two sinuses of Valsalva or left and non-coronary cusps fusion were excluded. Peak systolic circumferential wall shear stress (WSSc) and pulse wave velocity (PWV) in the ascending aorta (AAo) were assessed by 4D flow CMR. Fusion length between leaflets was measured using a stack of double-oblique cine CMR images of the aortic valve. Results The length of the fusion was effectively measured in 112/120 (93%) patients with good reproducibility (ICC = 0.826) and showed great variability (range 2.3–15.4 mm, 7.8±3.2 mm and tertiles cut-off points 6 and 9.3 mm). In multivariate analysis adjusted for clinical and demographic characteristics and PWV, fusion length was independently associated with the diameter at the sinus of Valsalva (p=0.002) and the AAo (p=0.02) (Table). WSSc progressively increased with larger fusion length (Figure), with statistical significance (p&lt;0.05) in the right and outer regions of the proximal and mid AAo. Conclusions Bicuspid aortic leaflet fusion length varies considerably, and it is independently associated with AAo and aortic root dilation, possibly through flow alterations. Figure 1. Maps of circumferential WSS Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study has been partially funded by Instituto Carlos III, Spanish Ministry of Science and Innovation (PI17/00381). Guala A. has received funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I).

An Assessment of Ca-Naphthenate-Epon Mixtures as Standards for Calcium Quantification in Aortic Valve Leaflets

1982 ◽  
Vol 40 ◽  
pp. 390-391
Author(s):  
Kathryn N. Colonna ◽  
Sydney S. Breese ◽  
Susan C. Sellers ◽  
J. David Deck
Keyword(s):  
Aortic Valve ◽  
Aortic Valves ◽  
X Ray ◽  
Aortic Valve Leaflets

Qualitative x-ray microanalytical studies used to demonstrate calcium in bioprosthetic aortic valves have shown that it occurs in a range of morphological forms. A consistent and reproducible standard for measuring calcium was necessary to investigate whether these forms represented varying concentrations of calcium. To provide such a standard, we tested a series of calcium naphthenate-epon mixtures.

scholarly journals Quantitative 4D Flow CMR analysis of intracardiac blood flow energetics in ischemic cardiomyopathy patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Riva ◽  
A Camporeale ◽  
F Sturla ◽  
S Pica ◽  
L Tondi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Cardiomyopathy ◽  
Inverse Correlation ◽  
Lv Function ◽  
Funding Source ◽  
4D Flow ◽  
Anterior Myocardial Infarction ◽  
National Budget ◽  
4D Flow Cmr ◽  
Public Grant

Abstract Background Ischemic cardiomyopathy (ICM) is often associated with negative LV remodelling after myocardial infarction, sometimes resulting in impaired LV function and dilation (iDCM). 4D Flow CMR has been recently exploited to assess intracardiac hemodynamic changes in presence of LV remodelling. Purpose To quantify 4D Flow intracardiac kinetic energy (KE) and viscous energy loss (EL) and investigate their relation with LV dysfunction and remodelling. Methods Patients with prior anterior myocardial infarction underwent a CMR study with 4D Flow sequences acquisition; they were divided into ICM (n=10) and iDCM (n=10, EDV&gt;208 ml and EF&lt;40%). 10 controls were used for comparison. LV was semi-automatically segmented using short axis CMR stacks and co-registered with 4D Flow. Global KE and EL were computed over the cardiac cycle. NT-proBNP measurements were correlated with average and peak values, during systole and diastole. Results Both LV volume and EF significantly differ (P&lt;0.0001) between iDCM (EDV=294±56 ml, EF=24±8%), ICM (EDV=181±32 ml, EF=34±6%) and controls (EDV=124±29 ml, EF=72±5%). If compared to controls, both ICM and iDCM showed significantly lower KE (P≤0.0008); though lower than controls, EL was higher in iDCM than ICM. Within the iDCM subgroup, diastolic mean KE and peak EL reported good inverse correlation with NT-proBNP (r=−0.75 and r=−0.69, respectively). EL indexed (ELI) to average KE during systole was higher in the entire ischemic group as compared to controls (ELI(ischemic) = 0.17 vs. ELI(controls) = 0.10, P=0.0054). Conclusions 4D Flow analyses effectively mapped post-ischemic LV energetic changes, highlighting the disproportionate intraventricular EL relative to produced KE; preliminary good correlation between LV energetic changes and NT-proBNP will deserve further investigation in order to contribute to early detection of heart failure. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health

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