Quantification of Respiratory Movement of the Aorta and Side Branches

Sailer, Anna M.; Wagemans, Bart A. J. M.; Das, Marco; Haan, Michiel W. de; Nelemans, Patricia J.; Wildberger, Joachim E.; Schurink, Geert Willem H.

doi:10.1177/1526602815605325

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…The 4D flow studies were acquired without respiratory gating. This should not imply substantial differences in the descending aorta, where respiratory motion is limited [31], especially during tidal breathing [32], as in the present investigation. The cross-sectional nature of the study implies the impossibility of investigating causal relationship between variables.…”

Section: Discussionmentioning

confidence: 82%

Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

Guala

Teixidó-Turà

Dux-Santoy

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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BackgroundDiseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined.MethodsSeventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed.ResultsIn-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter.ConclusionsReduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.Electronic supplementary materialThe online version of this article (10.1186/s12968-019-0572-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 82%

Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

Guala

Teixidó-Turà

Dux-Santoy

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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“…Other studies have noted similar findings among individuals with both healthy aortas and in those with untreated native aortic disease. 5,6,18 Stiffness increase of aortic wall due to TEVAR and its effect on nonstented segment was well reported from studies with ex vivo porcine model. 25,26 Based on these evidences, we opine that the longitudinal and diametric rigidity introduced by the thoracic aortic stent graft damps the cardiopulmonary-induced aortic displacement of the stented descending thoracic aorta and thereby augments the deformations observed across the native aortic segments.…”

Section: Arclength (Cm)mentioning

confidence: 86%

“…the abdominal aorta and the renovisceral vessels both before and after endovascular aneurysm repair. 3,13 Sailer et al 18 performed quantitative 3D subtraction analysis in 60 patients and recorded complex arterial motion during respiration, including deformation of the aorta and side branches in the anterior, medial, and caudal directions during the inspiratory state compared with the expiration state. Similar to our study, they observed respiratory movement to be of greatest magnitude in the ascending aorta and origins of the arch branches.…”

Section: Arclength (Cm)mentioning

confidence: 99%

Cardiopulmonary-induced deformations of the thoracic aorta following thoracic endovascular aortic repair

et al. 2018

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Objectives Thoracic endovascular aortic repair has become a preferred treatment strategy for thoracic aortic aneurysms and dissections. Yet, it is not well understood if the performance of endografts is affected by physiologic strain due to cyclic aortic motion during cardiac pulsation and respiration. We aim to quantify cardiac- and respiratory-induced changes of the postthoracic endovascular aortic repair thoracic aorta and endograft geometries. Methods Fifteen thoracic endovascular aortic repair patients (66 ± 10 years) underwent cardiac-resolved computed tomography angiographies during inspiratory/expiratory breath holds. The computed tomography angiography images were utilized to build models of the aorta, and lumen centerlines and cross-sections were extracted. Arclength and curvature were computed from the lumen centerline. Effective diameter was computed from cross-sections of the thoracic aorta. Deformation was computed from the mid-diastole to end-systole (cardiac deformation) and expiration to inspiration (respiratory deformation). Results Cardiac pulsation induced significant changes in arclength, mean curvature, maximum curvature change, and effective diameter of the ascending aorta, as well as effective diameter of the stented aortic segment. Respiration, however, induced significant change in mean curvature and effective diameter of the ascending aorta only. Cardiac-induced arclength change of the ascending aorta was significantly greater than respiratory-induced arclength change. Conclusions Deformations are present across the thoracic aorta due to cardiopulmonary influences after thoracic endovascular aortic repair. The geometric deformations are greatest in the ascending aorta and decline at the stented thoracic aorta. Additional investigation is warranted to correlate aortic deformation to endograft performance.

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“…According to Sailer et al (25) the respiration induced displacement of the visceral and renal target vessels during a normal, self-controlled breathing cycle is on average 1.4 mm, oriented in exclusively the cranio-caudal direction (z-axis). Thus, while our study outcomes may have been affected by respiratory movements, but the contribution will be small and only oriented in the cranio-caudal direction.…”

Section: Discussionmentioning

confidence: 99%

Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps

Jansen¹,

Stelt²,

Smorenburg³

et al. 2021

Quant Imaging Med Surg

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Background: This retrospective study quantifies target vessel displacement during fenestrated and branched endovascular aneurysm repair due to the introduction of stiff guidewires and stent graft delivery systems. The effect that intraoperative vessel displacement has on the usability of computed tomography angiography (CTA) roadmaps is also addressed.Methods: Patients that underwent fenestrated or branched EVAR were included in this retrospective study.Two imaging datasets were collected from each patient: (I) preoperative CTA and (II) intraoperative contrastenhanced cone beam computed tomography (ceCBCT) acquired after the insertion of the stiff guidewire and stent graft delivery system. After image registration, the 3D coordinates of the ostium of the celiac artery, superior mesenteric artery, right renal artery and left renal artery were recorded in both the CTA and the ceCBCT dataset by two observers. The three-dimensional displacement of the ostia of the target vessels was calculated by subtracting the coordinates of CTA and ceCBCT from one another. Additionally, the tortuosity index and the maximum angulation of the aorta were calculated.Results: In total 20 patients and 77 target vessels were included in this study. The ostium of the celiac, superior mesenteric, right renal and left renal artery underwent non-uniform three-dimensional displacement with mean absolute displacement of 8.2, 7.7, 8.2 and 6.2 mm, respectively. The average displacement of all different target vessels together was 7.8 mm. A moderate correlation between vessel displacement and the maximum angulation of the aortoiliac segment was found (Spearman's ρ=0.45, P<0.05). Conclusions:The introduction of stiff endovascular devices during fenestrated or branched EVAR causes significant, non-uniform displacement of the ostium of the visceral and renal target vessels. Consequently, preoperative CTA roadmaps based on bone registration are suboptimal to guide target vessel catheterization during these procedures.

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Quantification of Respiratory Movement of the Aorta and Side Branches

Abstract: The aorta and side branches undergo considerable respiratory movement. The results from this study provide an important contribution to understanding aortic dynamics.

Cited by 16 publications

References 22 publications

Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study

Cardiopulmonary-induced deformations of the thoracic aorta following thoracic endovascular aortic repair

Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps

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