Abstract 14914: Advanced 4D-flow Measurements of Aortic Forward Flow, Reverse Flow, and Stasis in Bicuspid Aortic Valve Patients Without Aortic Stenosis or Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Patrick Geeraert ◽  
Fatemehsadat jamalidinan ◽  
Ali Fatehi Hassanabad ◽  
James White ◽  
Julio Garcia Flores
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Cardiac Cycle ◽  
Reverse Flow ◽  
Left Ventricular ◽  
Healthy Controls ◽  
4D Flow ◽  
Descending Aorta ◽  
Forward Flow

Introduction: Precise analysis of aortic hemodynamics is crucial in the study of bicuspid aortic valve (BAV) disease. This study provides a comprehensive evaluation of aortic forward flow (FF), reverse flow (RF) and stasis in BAV patients using novel 3D-based techniques previously shown to be more accurate than traditional 2D analysis methods. Hypothesis: BAV patients without valve dysfunction show abnormal aortic FF, RF, and stasis compared to healthy controls. Methods: We recruited 44 BAV patients (48±15 yrs, 27% female) and 23 healthy controls (37±14 yrs, 35% female). Cardiac MRI at 3T was performed inclusive of 4D-flow imaging. Patients with any aortic stenosis (AS) or ≥mild regurgitation (AR) were excluded. Flow analysis was performed by segmented volumetric regions: left ventricular outflow tract (LVOT), ascending aorta (AAo), arch, proximal descending aorta (PDAo), and distal descending aorta (DDAo). In each region, forward flow (FF), reverse flow (RF) and stasis were averaged over the cardiac cycle on a voxel-by-voxel basis. Left ventricular (LV) end-diastolic volume, end-systolic volume and ejection fraction were also measured. T-tests (or non-parametric equivalent) compared differences in parameters between cohorts. Results: BAV patients were significantly older than controls (48±15 vs. 37±14 yrs; p=0.01) but exhibited no significant differences in LV measures. Patients showed reduced FF in the AAo (0.09±0.03 vs. 0.11±0.04 mL/cycle; p<0.01), but greater FF in all downstream regions (eg. PDA: 0.02±0.03 vs. 0.01±0.02 mL/cycle; p=0.01). RF was significantly elevated in patients in the AAo (0.06±0.02 vs. 0.02±0.02 mL/cycle; p<0.01). BAV patients exhibited significantly less stasis in every region except the DDAo (eg. AAo: 23±11 vs. 50±10 % of cardiac cycle). Conclusions: 3D-derived measurements of FF, RF, and stasis are significantly altered in the thoracic aorta of BAV patients in the absence of AS or AR.

scholarly journals Hemodynamic Assessment in Bicuspid Aortic Valve Disease and Aortic Dilation: New Insights From Voxel-By-Voxel Analysis of Reverse Flow, Stasis, and Energetics

2022 ◽  
Vol 9 ◽  
Author(s):  
Patrick Geeraert ◽  
Fatemehsadat Jamalidinan ◽  
Fiona Burns ◽  
Kelly Jarvis ◽  
Michael S. Bristow ◽  
...  
Keyword(s):  
Peak Velocity ◽  
Reverse Flow ◽  
Aortic Surgery ◽  
Healthy Controls ◽  
Aortic Dilation ◽  
4D Flow Mri ◽  
4D Flow ◽  
Descending Aorta ◽  
Forward Flow ◽  
Flow Mri

Objectives: Clinical management decisions surrounding ascending aorta (AAo) dilation in bicuspid aortic valve (BAV) disease benefit from personalized predictive tools. 4D-flow MRI may provide patient-specific markers reflective of BAV-associated aortopathy. This study aims to explore novel 4D-flow MRI parametric voxel-by-voxel forward flow, reverse flow, kinetic energy and stasis in BAV disease. We hypothesize that novel parametric voxel-by-voxel markers will be associated with aortic dilation and referral for surgery and can enhance our understanding of BAV hemodynamics beyond standard metrics.Methods: A total of 96 subjects (73 BAV patients, 23 healthy controls) underwent MRI scan. Healthy controls had no known cardiovascular disease. Patients were clinically referred for AAo dilation assessment. Indexed diameters were obtained by dividing the aortic diameter by the patient’s body surface area. Patients were followed for the occurrence of aortic surgery. 4D-flow analysis was performed by a single observer in five regions: left ventricular outflow tract (LVOT), AAo, arch, proximal descending aorta (PDAo), and distal descending aorta (DDAo). In each region peak velocity, kinetic energy (KE), forward flow (FF), reverse flow (RF), and stasis were measured on a voxel-by-voxel basis. T-tests (or non-parametric equivalent) compared flow parameters between cohorts. Univariate and multivariate analyses explored associations between diameter and parametric voxel-by-voxel parameters.Results: Compared to controls, BAV patients showed reduced stasis (p &lt; 0.01) and increased RF and FF (p &lt; 0.01) throughout the aorta, and KE remained similar. In the AAo, indexed diameter correlated with age (R = 0.326, p = 0.01), FF (R = −0.648, p &lt; 0.001), RF (R = −0.441, p &lt; 0.001), and stasis (R = −0.288, p &lt; 0.05). In multivariate analysis, FF showed a significant inverse association with AAo indexed diameter, independent of age. During a median 179 ± 180 days of follow-up, 23 patients (32%) required aortic surgery. Compared to patients not requiring surgery, they showed increased KE and peak velocity in the proximal aorta (p &lt; 0.01), accompanied by increased RF and reduced stasis throughout the entire aorta (p &lt; 0.01).Conclusion: Novel voxel-by-voxel reverse flow and stasis were altered in BAV patients and are associated with aortic dilation and surgical treatment.

Left ventricular outflow tract obstruction (LVOTO)

2011 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Different Levels

Introduction 68Subvalvar aortic stenosis (AS) 70Bicuspid aortic valve 72Supravalvar AS 74LVOTO may occur at different levels: • Subvalvular.• Valvular—including bicuspid aortic valve.• Supravalvular.• Coarctation— see p.118.Effects of LVOTO, irrespective of site of lesion, are: • ↑ afterload on LV....

scholarly journals Causal Relationship of Transverse Left Ventricular Band and Bicuspid Aortic Valve

2021 ◽  
Author(s):  
Manoj Kumar Dubey ◽  
Avinash Mani ◽  
Vineeta Ojha
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Surrogate Marker ◽  
Left Ventricular ◽  
The Other ◽  
Average Thickness ◽  
Transverse Band ◽  
Study Population ◽  
Relationship Of

Objectives: Bicuspid aortic valve is the most common congenital lesion found in adults. It is can be seen in combination with a transverse left ventricular (LV) band. We aimed to find an essential relationship between the presence of transverse ventricular band and bicuspid aortic valve. Methods: 13 patients with transverse left ventricular band were investigated during a 6 month period from January 2019 to July 2019. LV band thickness and gradients at the site of the LV band were evaluated as part of its effect on LV hemodynamics. Morphology of aortic valve and LV outflow tract gradients were assessed. We aimed to establish the presence of robust LV band as a surrogate marker for bicuspid aortic valve and evaluate the effect of LV band on LV hemodynamics. Results: Mean age of study population was 41yrs. Majority had bicuspid aortic valve(n=11). Average thickness of transverse band was 6.2mm and average mean aortic gradient was4mmHg. Sequestration of blood was noted at the level of transverse band in all the patients with 2 separate jets at LVOT. Anterolateral jet was deflected from transverse band and showed higher velocity in comparison to the other jet, causing turbulence at the bicuspid aortic valve. No co-relation was found between the thickness of transverse band and aortic valve gradient. Conclusion: Presence of a robust transverse LV band can serve as a surrogate marker for bicuspid aortic valve. Keywords: Bicuspid aortic valve ; aortic stenosis

Genetic and Developmental Contributors to Aortic Stenosis

2021 ◽  
Vol 128 (9) ◽  
pp. 1330-1343 ◽  
Author(s):  
Punashi Dutta ◽  
Jeanne F. James ◽  
Hail Kazik ◽  
Joy Lincoln
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Financial Burden ◽  
Left Ventricular ◽  
Valve Disease ◽  
Outflow Obstruction ◽  
Left Ventricular Outflow Obstruction ◽  
Ventricular Outflow Obstruction ◽  
Left Ventricular Outflow

Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.

Left ventricular outflow tract obstruction

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Valvular Aortic Stenosis

Conditions that result in left ventricular outflow tract obstruction, i.e. valvular aortic stenosis, due to a bicuspid aortic valve, and subvalvular and supravalvular aortic stenosis are discussed.

scholarly journals Impaction of Regurgitation Jet on Anterior Mitral Leaflet Causes Diastolic Dysfunction in Patients With Bicuspid Aortic Valve and Mild Insufficiency: A Cardiovascular Magnetic Resonance Study

2021 ◽  
Author(s):  
Nicola Galea ◽  
Giacomo Pambianchi ◽  
Giulia Cundari ◽  
Francesco Sturla ◽  
Livia Marchitelli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Control Group ◽  
Cardiovascular Magnetic Resonance Study ◽  
Flow Imaging ◽  
4D Flow ◽  
The Impact ◽  
4D Flow Imaging

Abstract Purpose: To assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging.Methods: Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain.Results: Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10±0.2 s-1 vs 1.34±0.5 s-1 vs 1.53±0.3 s-1 , p:0.001 and 0.68±0.2 s-1 vs 1.17±0.2 s-1 vs 1.05±0.4 s-1 ; p<0.001, PDV = -101.6±28.1 deg/s vs -201.4±85.9 deg/s vs - 221.6±67.1 deg/s; p<0.001 and -28.1±8 mm/s vs -38.9±11.1 mm/s vs -43.6±14.3 mm/s, p<0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups.Conclusion: In BAV patients with AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling

scholarly journals Impaction of regurgitation jet on anterior mitral leaflet is associated with diastolic dysfunction in patients with bicuspid aortic valve and mild insufficiency: a cardiovascular magnetic resonance study

2021 ◽  
Author(s):  
Nicola Galea ◽  
Giacomo Pambianchi ◽  
Giulia Cundari ◽  
Francesco Sturla ◽  
Livia Marchitelli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Control Group ◽  
Cardiovascular Magnetic Resonance Study ◽  
Flow Imaging ◽  
4D Flow ◽  
The Impact ◽  
4D Flow Imaging

AbstractTo assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging. Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain. Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10 ± 0.2 1/s vs. 1.34 ± 0.5 1/s vs. 1.53 ± 0.3 1/s, p:0.001 and 0.68 ± 0.2 1/s vs. 1.17 ± 0.2 1/s vs. 1.05 ± 0.4 1/s ; p < 0.001, PDV = − 101.6 ± 28.1 deg/s vs. − 201.4 ± 85.9 deg/s vs. − 221.6 ± 67.1 deg/s; p < 0.001 and − 28.1 ± 8 mm/s vs. − 38.9 ± 11.1 mm/s vs. − 43.6 ± 14.3 mm/s, p < 0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups. In BAV patients with mild AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling.

scholarly journals Rheumatic Bicuspid Aortic Valve Causing Device Embolization during Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Uoo Kim
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Device Embolization

Transcatheter aortic valve replacement (TAVR) has emerged as a feasible alternative for treatment of severe aortic stenosis with comparable outcomes to surgical aortic valve replacement (SAVR) in recent years. We present a case of device embolization in the left ventricular outflow tract (LVOT) during TAVR in a patient with severe aortic stenosis that required emergent surgical intervention. During the open-heart surgery for embolized prosthesis extraction and SAVR, both TEE exam and surgical specimen demonstrated bicuspid aortic valve and rheumatic nature of the valve with lack of calcification, which were identified to be the two main factors that contributed to the complication. In which the insufficient annular calcification increases the risk of device embolization due to lack of an adequate landing zone for device anchoring, and the anatomy of bicuspid valve contributes to the complication due to its associated large annular size and horizontal aorta. This case highlights device embolization as one possible complication of TAVR which is associated with substantial morbidity and mortality, the clinical management process was thoroughly documented with aortic angiography and transoesophageal echocardiography imaging.

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