Andrea Guala1,2, Arturo Evangelista3,4,5,6,7, Gisela Teixido-Tura8,9,10, Lucia La Mura8,10,11, Lydia Dux-Santoy10, Aroa Ruiz-Muñoz9, Filipa Valente10, Laura Galian-Gay10, Laura Gutiérrez10, Teresa González-Alujas10, Ilaria Dentamaro10,12, Kevin M Johnson13, Oliver Wieben13, Augusto Sao Avilés8, Ignacio Ferreira-Gonzalez8,10,14,15, Jose F Rodríguez-Palomares8,9,10. 1. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. andrea.guala@yahoo.com. 2. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. andrea.guala@yahoo.com. 3. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. arturevangelistamasip@gmail.com. 4. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. arturevangelistamasip@gmail.com. 5. Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. arturevangelistamasip@gmail.com. 6. Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain. arturevangelistamasip@gmail.com. 7. Universitat Autònoma de Barcelona, Bellaterra, Spain. arturevangelistamasip@gmail.com. 8. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. 9. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. 10. Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 11. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy. 12. Department of Cardiology, Hospital "F. Miulli", Acquaviva delle Fonti, Italy. 13. Departments of Medical Physics & Radiology, University of Wisconsin, Madison, WI, USA. 14. Universitat Autònoma de Barcelona, Bellaterra, Spain. 15. CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain.
Abstract
OBJECTIVE: Bicuspid aortic valve (BAV), the most common congenital valve defect, is associated with increased risk of aortic dilation and related complications; however, current risk assessment is not effective. Most of BAV have three leaflets with a fusion between two of them of variable length. This study aimed to ascertain whether the extent of leaflet fusion (often called raphe) is related to aortic dilation and flow abnormalities in BAV with no significant valvular dysfunction. METHODS: One hundred and twenty BAV patients with no significant valvular dysfunction or history of surgical repair or aortic valve replacement were consecutively and prospectively enrolled (September 2014-October 2018). Cardiac magnetic resonance protocol included a 4D flow sequence for haemodynamic assessment. Moreover, a stack of double-oblique cine images of the aortic valve were used to quantify fusion length (in systole) and leaflet length (diastole). Inter- and intra-observer reproducibility was tested in 30 randomly selected patients. RESULTS: Aortic valve leaflet fusion was measurable in 112 of 120 (93%) cases with good reproducibility (ICC = 0.826). Fusion length varied greatly (range: 2.3-15.4 mm; mean: 7.8 ± 3.2 mm). After correction for demographic and clinical conditions, fusion length was independently associated with diameter and z-score at the sinus of Valsalva (p = 0.002 and p = 0.002, respectively) and ascending aorta (p = 0.028 and p = 0.046). Fusion length was positively related to flow asymmetry, vortices and circumferential wall shear stress, thereby possibly providing a pathophysiological link with aortic dilation. CONCLUSIONS: Aortic valve fusion length is related to aortic dilation and flow abnormalities in BAV patients. KEY POINTS: • The length of the fusion between leaflets in non-dysfunctional bicuspid aortic valves varies substantially and can be reliably measured by cine CMR. • Aortic valve leaflet fusion length is independently related to aortic sinus and ascending aorta diameter. • Increased flow asymmetry, circumferential wall shear stress and presence of vortices are positively related to aortic valve leaflet fusion length.
OBJECTIVE:Bicuspid aortic valve (BAV), the most common congenital valve defect, is associated with increased risk of aortic dilation and related complications; however, current risk assessment is not effective. Most of BAV have three leaflets with a fusion between two of them of variable length. This study aimed to ascertain whether the extent of leaflet fusion (often called raphe) is related to aortic dilation and flow abnormalities in BAV with no significant valvular dysfunction. METHODS: One hundred and twenty BAV patients with no significant valvular dysfunction or history of surgical repair or aortic valve replacement were consecutively and prospectively enrolled (September 2014-October 2018). Cardiac magnetic resonance protocol included a 4D flow sequence for haemodynamic assessment. Moreover, a stack of double-oblique cine images of the aortic valve were used to quantify fusion length (in systole) and leaflet length (diastole). Inter- and intra-observer reproducibility was tested in 30 randomly selected patients. RESULTS: Aortic valve leaflet fusion was measurable in 112 of 120 (93%) cases with good reproducibility (ICC = 0.826). Fusion length varied greatly (range: 2.3-15.4 mm; mean: 7.8 ± 3.2 mm). After correction for demographic and clinical conditions, fusion length was independently associated with diameter and z-score at the sinus of Valsalva (p = 0.002 and p = 0.002, respectively) and ascending aorta (p = 0.028 and p = 0.046). Fusion length was positively related to flow asymmetry, vortices and circumferential wall shear stress, thereby possibly providing a pathophysiological link with aortic dilation. CONCLUSIONS: Aortic valve fusion length is related to aortic dilation and flow abnormalities in BAV patients. KEY POINTS: • The length of the fusion between leaflets in non-dysfunctional bicuspid aortic valves varies substantially and can be reliably measured by cine CMR. • Aortic valve leaflet fusion length is independently related to aortic sinus and ascending aorta diameter. • Increased flow asymmetry, circumferential wall shear stress and presence of vortices are positively related to aortic valve leaflet fusion length.
Entities:
Keywords:
Aneurysm; Bicuspid aortic valve; Haemodynamics; Magnetic resonance imaging
Authors: Laura Galian-Gay; Amelia Carro Hevia; Gisela Teixido-Turà; José Rodríguez Palomares; Laura Gutiérrez-Moreno; Giuliana Maldonado; María Teresa Gonzàlez-Alujas; Augusto Sao-Aviles; Pastora Gallego; Francisco Calvo-Iglesias; Javier Bermejo; Juan Robledo-Carmona; Violeta Sánchez; Daniel Saura; Teresa Sevilla; Sergio Burillo-Sanz; Andrea Guala; David Garcia-Dorado; Arturo Evangelista Journal: Heart Date: 2018-10-15 Impact factor: 5.994
Authors: A Guala; G Teixido-Tura; L Dux-Santoy; C Granato; A Ruiz-Muñoz; F Valente; L Galian-Gay; L Gutiérrez; T González-Alujas; K M Johnson; O Wieben; A Sao Avilés; A Evangelista; J Rodriguez-Palomares Journal: J Cardiovasc Magn Reson Date: 2019-10-14 Impact factor: 5.364
Authors: José Fernando Rodríguez-Palomares; Lydia Dux-Santoy; Andrea Guala; Raquel Kale; Giuliana Maldonado; Gisela Teixidó-Turà; Laura Galian; Marina Huguet; Filipa Valente; Laura Gutiérrez; Teresa González-Alujas; Kevin M Johnson; Oliver Wieben; David García-Dorado; Arturo Evangelista Journal: J Cardiovasc Magn Reson Date: 2018-04-26 Impact factor: 5.364
Authors: Julio Sotelo; Pamela Franco; Andrea Guala; Lydia Dux-Santoy; Aroa Ruiz-Muñoz; Arturo Evangelista; Hernan Mella; Joaquín Mura; Daniel E Hurtado; José F Rodríguez-Palomares; Sergio Uribe Journal: Front Cardiovasc Med Date: 2022-05-18