Bicuspid Aortic Valve: Four-dimensional MR Evaluation of Ascending Aortic Systolic Flow Patterns

Hope, Michael D.; Hope, Thomas A.; Meadows, Alison Knauth; Ordovás, Karen; Urbania, Thomas H.; Alley, Marcus T.; Higgins, Charles B.

doi:10.1148/radiol.09091437

Cited by 382 publications

(342 citation statements)

References 33 publications

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“…Barker et al and Hope et al were the first to link eccentric flow patterns in BAV disease with WSS, as measured with 2D flow MRI and 4D flow MRI, respectively 29, 30. Similar to our study, maximum systolic WSS was found in different aortic regions for RL‐BAV and RN‐BAV.…”

Section: Discussionsupporting

confidence: 88%

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Ooij

Markl

Collins

et al. 2017

JAHA

133

104

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BackgroundWall shear stress (WSS) is a stimulus for vessel wall remodeling. Differences in ascending aorta (AAo) hemodynamics have been reported between bicuspid aortic valve (BAV) and tricuspid aortic valve patients with aortic dilatation, but the confounding impact of aortic valve stenosis (AS) is unknown.Methods and ResultsFive hundred seventy‐one subjects underwent 4‐dimensional flow magnetic resonance imaging in the thoracic aorta (210 right‐left BAV cusp fusions, 60 right‐noncoronary BAV cusp fusions, 245 tricuspid aortic valve patients with aortic dilatation, and 56 healthy controls). There were 166 of 515 (32%) patients with AS. WSS atlases were created to quantify group‐specific WSS patterns in the AAo as a function of AS severity. In BAV patients without AS, the different cusp fusion phenotypes resulted in distinct differences in eccentric WSS elevation: right‐left BAV patients exhibited increased WSS by 9% to 34% (P<0.001) at the aortic root and along the entire outer curvature of the AAo whereas right‐noncoronary BAV patients showed 30% WSS increase (P<0.001) at the distal portion of the AAo. WSS in tricuspid aortic valve patients with aortic dilatation patients with no AS was significantly reduced by 21% to 33% (P<0.01) in 4 of 6 AAo regions. In all patient groups, mild, moderate, and severe AS resulted in a marked increase in regional WSS (P<0.001). Moderate‐to‐severe AS further increased WSS magnitude and variability in the AAo. Differences between valve phenotypes were no longer apparent.Conclusions AS significantly alters aortic hemodynamics and WSS independent of aortic valve phenotype and over‐rides previously described flow patterns associated with BAV and tricuspid aortic valve with aortic dilatation. Severity of AS must be considered when investigating valve‐mediated aortopathy.

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Section: Discussionsupporting

confidence: 88%

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Ooij

Markl

Collins

et al. 2017

JAHA

133

104

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“…Nevertheless, increased vortex flow provides the potential haemodynamic basis for the development of aortopathy. 18,39,40 Our findings suggest that BAV relatives are more likely to have altered aortic shapes associated with abnormal aortic blood flow patterns, which have been associated with pathologic aneurysmal dilatation. Additional studies in larger cohorts are warranted to investigate the impact of aortic shape on flow patterns in the absence of valvular disease.…”

Section: Discussionmentioning

confidence: 69%

Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns

Schnell

Smith²,

Barker

et al. 2016

Eur Heart J Cardiovasc Imaging

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AimsBicuspid aortic valve (BAV) is known to exhibit familial inheritance and is associated with aortopathy and altered aortic haemodynamics. However, it remains unclear whether BAV-related aortopathy can be inherited independently of valve morphology. Methods and resultsFour-dimensional flow magnetic resonance imaging for the in vivo assessment of thoracic aortic 3D blood flow was performed in 24 BAV relatives with trileaflet aortic valves (age ¼ 40 + 14 years) and 15 healthy controls (age ¼ 37 + 10 years). Data analysis included aortic dimensions, shape (round/gothic/cubic), and 3D blood flow characteristics (semiquantitative vortex/helix grading and peak velocities). Cubic and gothic aortic shapes were markedly more prevalent in BAV relatives compared with controls (38 vs. 7%). Ascending aorta (AAo) vortex flow in BAV relatives was significantly increased compared with controls (grading ¼ 1.5 + 1.0 vs. 0.6 + 0.9, P ¼ 0.015). Aortic haemodynamics were influenced by aortic shape: peak velocities were reduced for gothic aortas vs. round aortas (P ¼ 0.003); vortex flow was increased for cubic aortas in the AAo (P , 0.001) and aortic arch (P ¼ 0.004); vortex and helix flows were elevated for gothic aortas in the AAo and descending aorta (P ¼ 0.003, P ¼ 0.029). Logistic regression demonstrated significant associations of shape with severity of vortex flow in AAo (P , 0.001) and aortic arch (P ¼ 0.016) in BAV relatives. ConclusionBAV relatives expressed altered aortic shape and increased vortex flow despite the absence of valvular disease or aortic dilatation. These data suggest a heritable component of BAV-related aortopathy affecting aortic shape and aberrant blood flow, independent of valve morphology.--

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“…Bicuspid aortic valves produce distinctive helical blood flow patterns within the aorta, a finding that supports the importance of hemodynamics in the progressive aortopathy seen with BAV (16,17). While valve replacement improves transvalvular gradients and relieves patient symptoms, studies using advanced three-dimensional MRI blood flow imaging ("4D Flow") have shown that ascending aortic flow patterns remain markedly abnormal despite aortic valve replacement (18).…”

mentioning

confidence: 77%

Evolving treatment options for valve and aortic disease with bicuspid aortic valve

Burris

Hope

2017

Ann. Transl. Med.

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Bicuspid Aortic Valve: Four-dimensional MR Evaluation of Ascending Aortic Systolic Flow Patterns

Cited by 382 publications

References 33 publications

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4‐Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects

Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns

Evolving treatment options for valve and aortic disease with bicuspid aortic valve

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