OBJECTIVE: To provide more complete characterization of ascending aortic blood flow, including vortex formation behind the valve cusps, in healthy subjects and patients after valve-sparing aortic root replacement (David reimplantation). METHODS: Time-resolved 3-dimensional magnetic resonance imaging velocity mapping was performed to analyze pulsatile blood flow by using encoded 3-directional vector fields in the thoracic aortas of 10 volunteers and 12 patients after David reimplantation using a cylindrical tube graft (T. David I) and two versions of neosinus recreation (T. David-V and T. David-V-S mod ). Aortic flow was evaluated by using 3-dimensional time-resolved particle traces and velocity vector fields reformatted onto 2-dimensional planes. Semiquantitative data were derived by using a blinded grading system (0-3: 0, none; 1, minimal; 2, medium; 3, prominent) to analyze the systolic vortex formation behind the cusps, as well as retrograde and helical flow in the ascending aorta. RESULTS: Systolic vortices were seen in both coronary sinuses of all volunteers (greater in the left sinus [2.5 +/- 0.5] than the right [1.8 +/- 0.8]) but in only 4 of 10 noncoronary sinuses (0.7 +/- 0.9). Comparable coronary vortices were detected in all operated patients. Vorticity was minimal in the noncoronary cusp in T. David-I repairs (0.7 +/- 0.7) but was prominent in T. David-V noncoronary graft pseudosinuses (1.5 +/- 0.6; P = .035). Retrograde flow (P = .001) and helicity (P = .028) were found in all patients but were not distinguishable from normal values in the T. David-V-S mod patients. CONCLUSIONS: Coronary cusp vorticity was preserved after David reimplantation, regardless of neosinus creation. Increased retrograde flow and helicity were more prominent in T. David-V patients. These novel magnetic resonance imaging methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing various types of valve-sparing aortic root replacement.
OBJECTIVE: To provide more complete characterization of ascending aortic blood flow, including vortex formation behind the valve cusps, in healthy subjects and patients after valve-sparing aortic root replacement (David reimplantation). METHODS: Time-resolved 3-dimensional magnetic resonance imaging velocity mapping was performed to analyze pulsatile blood flow by using encoded 3-directional vector fields in the thoracic aortas of 10 volunteers and 12 patients after David reimplantation using a cylindrical tube graft (T. David I) and two versions of neosinus recreation (T. David-V and T. David-V-S mod ). Aortic flow was evaluated by using 3-dimensional time-resolved particle traces and velocity vector fields reformatted onto 2-dimensional planes. Semiquantitative data were derived by using a blinded grading system (0-3: 0, none; 1, minimal; 2, medium; 3, prominent) to analyze the systolic vortex formation behind the cusps, as well as retrograde and helical flow in the ascending aorta. RESULTS: Systolic vortices were seen in both coronary sinuses of all volunteers (greater in the left sinus [2.5 +/- 0.5] than the right [1.8 +/- 0.8]) but in only 4 of 10 noncoronary sinuses (0.7 +/- 0.9). Comparable coronary vortices were detected in all operated patients. Vorticity was minimal in the noncoronary cusp in T. David-I repairs (0.7 +/- 0.7) but was prominent in T. David-V noncoronary graft pseudosinuses (1.5 +/- 0.6; P = .035). Retrograde flow (P = .001) and helicity (P = .028) were found in all patients but were not distinguishable from normal values in the T. David-V-S mod patients. CONCLUSIONS: Coronary cusp vorticity was preserved after David reimplantation, regardless of neosinus creation. Increased retrograde flow and helicity were more prominent in T. David-V patients. These novel magnetic resonance imaging methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing various types of valve-sparing aortic root replacement.
Authors: Umberto Morbiducci; Raffaele Ponzini; Giovanna Rizzo; Marco Evanghelos Biancolini; Francesco Iannaccone; Diego Gallo; Alberto Redaelli Journal: Med Biol Eng Comput Date: 2011-12-23 Impact factor: 2.602
Authors: S Wetzel; S Meckel; A Frydrychowicz; L Bonati; E-W Radue; K Scheffler; J Hennig; M Markl Journal: AJNR Am J Neuroradiol Date: 2007-03 Impact factor: 3.825
Authors: Edouard Semaan; Michael Markl; S Chris Malaisrie; Alex Barker; Bradley Allen; Patrick McCarthy; James C Carr; Jeremy D Collins Journal: Eur J Cardiothorac Surg Date: 2013-12-06 Impact factor: 4.191
Authors: Andrew L Wentland; Oliver Wieben; Dhanansayan Shanmuganayagam; Christian G Krueger; Jennifer J Meudt; Daniel Consigny; Leonardo Rivera; Patrick E McBride; Jess D Reed; Thomas M Grist Journal: J Magn Reson Imaging Date: 2014-06-25 Impact factor: 4.813
Authors: Stephan Meckel; Aurelien F Stalder; Francesco Santini; Ernst-Wilhelm Radü; Daniel A Rüfenacht; Michael Markl; Stephan G Wetzel Journal: Neuroradiology Date: 2008-03-19 Impact factor: 2.804
Authors: P Martijn den Reijer; Denver Sallee; Petra van der Velden; Eline R Zaaijer; W James Parks; Senthil Ramamurthy; Trevor Q Robbie; Giorgina Donati; Carey Lamphier; Rudolf P Beekman; Marijn E Brummer Journal: J Cardiovasc Magn Reson Date: 2010-01-13 Impact factor: 5.364