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. 2023 Feb 14:10:1071643.
doi: 10.3389/fcvm.2023.1071643. eCollection 2023.

Changes of aortic hemodynamics after aortic valve replacement-A four dimensional flow cardiovascular magnetic resonance follow up study

Stephanie Wiesemann  1   2   3 , Ralf Felix Trauzeddel  1   3   4 , Ahmed Musa  1 , Richard Hickstein  1 , Thomas Mayr  1 , Florian von Knobelsdorff-Brenkenhoff  1   5 , Emilie Bollache  6 , Michael Markl  7 , Jeanette Schulz-Menger  1   2   3
Affiliations

Changes of aortic hemodynamics after aortic valve replacement-A four dimensional flow cardiovascular magnetic resonance follow up study

Stephanie Wiesemann et al. Front Cardiovasc Med. .

Abstract

Objectives: Non-invasive assessment of aortic hemodynamics using four dimensional (4D) flow magnetic resonance imaging (MRI) provides new information on blood flow patterns and wall shear stress (WSS). Aortic valve stenosis (AS) and/or bicuspid aortic valves (BAV) are associated with altered aortic flow patterns and elevated WSS. Aim of this study was to investigate changes in aortic hemodynamics over time in patients with AS and/or BAV with or without aortic valve replacement.

Methods: We rescheduled 20 patients for a second 4D flow MRI examination, whose first examination was at least 3 years prior. A total of 7 patients received an aortic valve replacement between baseline and follow up examination (=operated group = OP group). Aortic flow patterns (helicity/vorticity) were assessed using a semi-quantitative grading approach from 0 to 3, flow volumes were evaluated in 9 planes, WSS in 18 and peak velocity in 3 areas.

Results: While most patients had vortical and/or helical flow formations within the aorta, there was no significant change over time. Ascending aortic forward flow volumes were significantly lower in the OP group than in the NOP group at baseline (NOP 69.3 mL ± 14.2 mL vs. OP 55.3 mL ± 1.9 mL p = 0.029). WSS in the outer ascending aorta was significantly higher in the OP group than in the NOP group at baseline (NOP 0.6 ± 0.2 N/m2 vs. OP 0.8 ± 0.2 N/m2, p = 0.008). Peak velocity decreased from baseline to follow up in the aortic arch only in the OP group (1.6 ± 0.6 m/s vs. 1.2 ± 0.3 m/s, p = 0.018).

Conclusion: Aortic valve replacement influences aortic hemodynamics. The parameters improve after surgery.

Keywords: 4D flow; aorta; aortic stenosis; aortic valve replacement; bicuspid aortic valve; cardiovascular magnetic resonance imaging.

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Conflict of interest statement

The authors received research support from Siemens Healthineers (JS-M, SW, and MM) and Circle Cardiovascular Imaging (JS-M and SW), research grants from Circle Cardiovascular Imaging (MM) and Cryolife Inc (MM), and performed activities in consulting Circle Cardiovascular Imaging (MM). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Consort flow diagram of patients enrollment.
Figure 2
Figure 2
Visualization of the locations used for quantitative assessment in the thoracic aorta. (A) Flow was evaluated in nine axial planes in the aorta. (B) WSS was evaluated in 18 aortic wall regions. (C) Peak velocity was evaluated in the ascending aorta, the aortic arch and the descending aorta. Notice the elevated peak velocity in the ascending aorta due to the pathologic aortic valve.
Figure 3
Figure 3
Example of helical (formula image) and vortical (formula image) flow formations changing in one patient before (A) and after (B) surgery. Notice the reduction of vortical flow formations between (A,B) and the increase of helical flow formations.
Figure 4
Figure 4
Hemodynamic measurements in the ascending aorta, the aortic arch and the descending aorta at baseline and follow up. (A) Forward flow volumes, (B) WSS, and (C) peak velocity.
Figure 5
Figure 5
Hemodynamic measurements in non-operated patients in the ascending aorta, the aortic arch and the descending aorta at baseline and follow up. (A) Forward flow volumes, (B) WSS, and (C) peak velocity.
Figure 6
Figure 6
Hemodynamic measurements in operated patients in the ascending aorta, the aortic arch and the descending aorta at baseline and follow up. (A) Forward flow volumes, (B) WSS, and (C) peak velocity.
See this image and copyright information in PMC

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