Blood Flow Patterns In The Ascending Aorta after TAVI And Surgical Aortic Valve Replacement: A Study Using 4D Flow MRI

2014 ◽  
Author(s):  
Ralf Felix Trauzeddel ◽  
Ulrike Löbe ◽  
Alex Barker ◽  
Carmen Gelsinger ◽  
Christian Butter ◽  
...  
Keyword(s):  
Blood Flow ◽  
Aortic Valve ◽  
Flow Patterns ◽  
Ascending Aorta ◽  
Shear Stresses ◽  
Healthy Controls ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri ◽  
Blood Flow Patterns

Background Transcatheter aortic valve implantation (TAVI) is a new method for treating patients with severe aortic stenosis with high risk for or rejected from conventional heart surgery. Its impact on blood flow patterns and parameters in the ascending aorta are unknown. Using 4-dimensional phase contrast MRI (4D Flow MRI) we examined the hemodynamics in the ascending aorta after TAVI and compared them to stented bioprostheses and healthy controls. Methods We used 4D Flow MRI (spatial resolution 1.8x1.8x2.5mm3; temporal resolution 13-22 phases/heart cycle) of the ascending aorta in 14 patients with TAVI (mean age 76 years, 8 males, all Edwards Sapien), 12 patients with different stented bioprostheses (mean age 77 years, 8 males) and 9 healthy controls (mean age 55 years, 8 males) controls using a 1.5T MR system. We examined the distribution of the maximum systolic wall shear stresses as well as the maximum blood flow velocities in the mid-ascending aorta. Results Patients with TAVI and stented bioprosthesis revealed an asymetric distribution of the wall shear stresses with significantly elevated values at the anterior and right-anterior curvature and significantly lower values at the posterior curvature compared to the healthy controls. Concerning the maximum velocities both TAVI and stented bioprostheses revealed an asymetric distribution along the right-anterior curvature where TAVI showed a more anterior distribution compared to the healty controls which showed a central distribution. Conclusion The blood flow patterns in patients with TAVI and stented bioprostheses differs significantly from the ones in healthy controls. However, TAVI and stented bioprosthesis showed small but significant regional differences.

scholarly journals Blood flow characteristics in the ascending aorta after aortic valve replacement—a pilot study using 4D-flow MRI

2014 ◽  
Vol 170 (3) ◽  
pp. 426-433 ◽  
Author(s):  
Florian von Knobelsdorff-Brenkenhoff ◽  
Ralf F. Trauzeddel ◽  
Alex J. Barker ◽  
Henriette Gruettner ◽  
Michael Markl ◽  
...  
Keyword(s):  
Blood Flow ◽  
Pilot Study ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Flow Characteristics ◽  
Ascending Aorta ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

scholarly journals Development of a New Approach for the Assessment of Complex Blood Flow Patterns in the Left Atrium From 4D Flow MRI

2018 ◽  
Author(s):  
Enrico Soldati ◽  
Thomas Dietenbeck ◽  
Alban Redheuil ◽  
Alessandro Masci ◽  
Sophia Houriez ◽  
...  
Keyword(s):  
Blood Flow ◽  
Left Atrium ◽  
Flow Patterns ◽  
4D Flow Mri ◽  
4D Flow ◽  
New Approach ◽  
Flow Mri ◽  
Blood Flow Patterns

Abstract 17363: Cardiac Output and Valve Orientation Affect Blood Flow Patterns Local to Bioprosthetic Pulmonary Valves in Tetralogy of Fallot

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicole Schiavone ◽  
Christopher Elkins ◽  
Doff B McElhinney ◽  
John K Eaton ◽  
Alison L Marsden
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Tetralogy Of Fallot ◽  
Flow Patterns ◽  
Velocity Fields ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri ◽  
Leaflet Motion ◽  
Blood Flow Patterns

Introduction: Tetralogy of Fallot (ToF) typically requires surgical repair of the right ventricular outflow tract (RVOT) and subsequent placement of an artificial pulmonary valve. Bioprosthetic valve longevity is highly variable and there is currently little understanding of what hemodynamic factors may lead to early valve dysfunction. Hypothesis: We hypothesize that cardiac output and valve orientation impact the performance of bioprosthetic valves by affecting blood flow patterns in the RVOT. Methods: We analyzed hemodynamics in a 3D printed ToF anatomy model in a physiological flow loop. A 25mm surgical valve was implanted in the model at two orientations: native and rotated 180 degrees. Full 3D, three-component, phase-averaged velocity fields were obtained over the cardiac cycle using 4D flow MRI at cardiac outputs of 2, 3.5, and 5 L/min. We acquired images of valve leaflet motion at 1500Hz. The 4D flow MRI and high-speed camera experiments were run identically, allowing us to examine the relationship between flow fields and leaflet motion. Results: The full velocity fields from the MRI scans revealed key differences among cases in flow features including location of reverse flow regions, systolic jet shape, and asymmetry local to the valve. At 2 L/min, the forward flow through the jet was more asymmetric compared to the other cases and a strong vortex formed, indicating a region of recirculation. With the rotated valve orientation, the 2 L/min case also produced a unique pattern as flow was washed from the RVOT inner curve back toward the center of the valve (Fig 1). Leaflet behavior during systole varied with cardiac output as well, as higher frequency flutter was observed at 5 L/min and the effective valve orifice area was decreased by 8.5% at 2 L/min compared to 5 L/min. Conclusions: We observed key differences in flow patterns and leaflet motion due to cardiac output and valve orientation that could impact leaflet loading and fatigue and long-term valve function.

scholarly journals Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease—A Systematic Review of the Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Daniel G. W. Cave ◽  
Hannah Panayiotou ◽  
Malenka M. Bissell
Keyword(s):  
Systematic Review ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Flow Patterns ◽  
Valve Disease ◽  
Aortic Dilatation ◽  
4D Flow Mri ◽  
4D Flow ◽  
Flow Mri

Bicuspid aortic valve (BAV) disease presents a unique management challenge both pre- and post-operatively. 4D flow MRI offers multiple tools for the assessment of the thoracic aorta in aortic valve disease. In particular, its assessment of flow patterns and wall shear stress have led to new understandings around the mechanisms of aneurysm development in BAV disease. Novel parameters have now been developed that have the potential to predict pathological aortic dilatation and may help to risk stratify BAV patients in future. This systematic review analyses the current 4D flow MRI literature after aortic valve and/or ascending aortic replacement in bicuspid aortic valve disease. 4D flow MRI has also identified distinct challenges posed by this cohort at the time of valve replacement compared to standard management of tri-leaflet disorders, and may help tailor the type and timing of replacement. Eccentric pathological flow patterns seen after bioprosthetic valve implantation, but not with mechanical prostheses, might be an important future consideration in intervention planning. 4D flow MRI also has promising potential in supporting the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.

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