Evaluation of Bicuspid Aortic Valve and Aortic Coarctation With 4D Flow Magnetic Resonance Imaging
2008; Lippincott Williams & Wilkins; Volume: 117; Issue: 21 Linguagem: Inglês
10.1161/circulationaha.107.760124
ISSN1524-4539
AutoresMichael D. Hope, Alison Knauth Meadows, Thomas A. Hope, Karen Ordovás, Gautham P. Reddy, Marcus T. Alley, Charles B. Higgins,
Tópico(s)Advanced MRI Techniques and Applications
ResumoHomeCirculationVol. 117, No. 21Evaluation of Bicuspid Aortic Valve and Aortic Coarctation With 4D Flow Magnetic Resonance Imaging Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBEvaluation of Bicuspid Aortic Valve and Aortic Coarctation With 4D Flow Magnetic Resonance Imaging Michael D. Hope, MD, Alison K. Meadows, MD, Thomas A. Hope, MD, Karen G. Ordovas, MD, Gautham P. Reddy, MD, Marcus T. Alley, PhD and Charles B. Higgins, MD Michael D. HopeMichael D. Hope From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). , Alison K. MeadowsAlison K. Meadows From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). , Thomas A. HopeThomas A. Hope From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). , Karen G. OrdovasKaren G. Ordovas From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). , Gautham P. ReddyGautham P. Reddy From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). , Marcus T. AlleyMarcus T. Alley From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). and Charles B. HigginsCharles B. Higgins From the Department of Radiology, University of California, San Francisco (M.D.H., A.K.M., T.A.H., K.G.O., G.P.R., C.B.H.); and the Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.T.A.). Originally published27 May 2008https://doi.org/10.1161/CIRCULATIONAHA.107.760124Circulation. 2008;117:2818–2819Time-resolved, 3D, phase-contrast magnetic resonance imaging (4D flow) is an effective means of evaluating dynamic multidirectional blood flow in the thoracic aorta.1 We have used the technique for characterization of abnormal flow features in a 14-year-old boy with aortic coarctation and bicuspid aortic valve (BAV) but without evidence of aortic stenosis or regurgitation. In addition to the expected flow disturbance in the region of the juxtaductal coarctation (Figure 1), we show an unusual flow feature in the ascending aorta that has not been previously reported in this clinical setting and that may be unique to BAV: 2 discrete nested helices of midsystolic blood flow in a nonaneurysmal aorta (Figure 2). Download figureDownload PowerPointFigure 1. Fourteen-year-old boy with BAV and aortic coarctation. A, Three-dimensional contrast-enhanced magnetic resonance angiography that demonstrates a focal juxtaductal coarctation and prominent internal mammary and intercostal arteries, consistent with collateral flow. B and C, Views of the right and left aspect of the aortic arch respectively with streamlines to visualize the 4D flow data set in midsystole. Streamlines are imaginary lines aligned with local vector fields and represent the flow field at a given moment in the cardiac cycle. They are color-coded for velocity. Marked flow disturbance is seen in the descending aorta at and distal to the coarctation, with acceleration of flow and regions of signal dropout secondary to aliasing. Additionally, note the eccentric right-sided flow jet and prominent helical flow in the ascending aorta, flow features that have been reported in association with ascending aortic aneurysms.2 D, Oblique sagittal T1 spin-echo image in the same orientation as Image C, which demonstrates only mild dilation of the ascending aorta (3.2 cm at the level of the main pulmonary artery).Download figureDownload PowerPointFigure 2. Focused evaluation of blood flow in the ascending aorta during midsystole with streamlines in right sagittal (A), oblique (B), and cross-sectional (C) orientations. Two discrete nested helices of blood flow are demonstrated, with a larger higher-velocity right-handed helix at the outer margins of the aortic lumen encircling a separate lower-velocity helix centrally. This is a secondary blood flow feature that has not been previously reported in this clinical context and may be unique to BAVs.Exaggerated helical flow has been described in the context of ascending aortic aneurysm, with the majority of cases seen in patients with aneurysmal dilation >4 cm.2 Our patient, however, had only mild dilation of the ascending aorta (3.2 cm at the level of the main pulmonary artery).BAV occurs in 1% to 2% of the population and may account for more morbidity and mortality than all other congenital cardiac malformations combined. One theory for the elevated risk of aortic aneurysm in these patients is that an increased hemodynamic load is placed on the proximal aorta, resulting in progressive aortic dilatation.3 Previous work has demonstrated that supraphysiological hemodynamics in the form of elevated shear stress, as seen in the radial artery proximal to an arteriovenous dialysis fistula, lead to an increase in vessel size.4 The pronounced helical flow and eccentric systolic jet in the ascending aorta that we have demonstrated may represent an increased hemodynamic burden and could predispose to aneurysm formation by a similar mechanism. Accurate calculation of wall shear stress in the ascending aorta, which may be possible using 4-dimensional flow data sets, and further characterization of blood flow features in patients with nonstenotic BAV are the next steps for evaluating this hypothesis.Additional Information About MethodsMagnetic resonance imaging data acquisition consisted of an rf-spoiled gradient echo sequence with velocity encoding in 3 spatial directions. Measurements were respiratory compensated and retrospectively gated to the ECG cycle. Scans were performed with an 8-channel cardiac coil and the following imaging parameters: Velocity encoded (VENC)=160 cm/s, fractional field of view (FOV=(300×270) mm2, slab thickness=78 mm, matrix=(256×192×30), spatial resolution= (1.17×1.56×2.60) mm3, temporal resolution=74.4 ms. Parallel imaging (GRAPPA) with an in-plane acceleration factor of 2 was used, with a scan time of 14 minutes. Data analysis and visualization were performed using a commercially available software package (EnSight, CEI, Apex, NC).DisclosuresDr Alley receives grant and research funding from GE Healthcare. The other authors report no conflicts.FootnotesCorrespondence to Michael D. Hope, MD, Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143–0628. E-mail [email protected] References 1 Markl M, Draney MT, Hope MD, Levin JM, Chan FP, Alley MT, Pelc NJ, Herfkens RJ. Time-resolved 3-dimensional velocity mapping in the thoracic aorta: visualization of 3-directional blood flow patterns in healthy volunteers and patients. J Comput Assist Tomogr. 2004; 28: 459–468.CrossrefMedlineGoogle Scholar2 Hope TA, Markl M, Wigström L, Alley MT, Miller DC, Herfkens RJ. Comparison of flow patterns in ascending aortic aneurysms and volunteers using four-dimensional magnetic resonance velocity mapping. J Magn Reson Imaging. 2007; 26: 1471–1479.CrossrefMedlineGoogle Scholar3 Davies RR, Kaple RK, Mandapati D, Gallo A, Botta DM, Elefteriades JA, Coady MA. Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve. Ann Thorac Surg. 2007; 83: 1338–1344.CrossrefMedlineGoogle Scholar4 Girerd X, London G, Boutouyrie P, Mourad JJ, Safar M, Laurent S. Remodeling of the radial artery in response to a chronic increase in shear stress. 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McNally A, Madan A and Sucosky P (2017) Morphotype-Dependent Flow Characteristics in Bicuspid Aortic Valve Ascending Aortas: A Benchtop Particle Image Velocimetry Study, Frontiers in Physiology, 10.3389/fphys.2017.00044, 8 Kim K, Kim D, Seo J, Cho I, Hong G, Ha J and Shim C (2021) Temporal Trends in Diagnosis, Treatments, and Outcomes in Patients With Bicuspid Aortic Valve, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2021.766430, 8 Sun L, Chandra S, Sucosky P and Aikawa E (2012) Ex Vivo Evidence for the Contribution of Hemodynamic Shear Stress Abnormalities to the Early Pathogenesis of Calcific Bicuspid Aortic Valve Disease, PLoS ONE, 10.1371/journal.pone.0048843, 7:10, (e48843) May 27, 2008Vol 117, Issue 21 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.760124PMID: 18506021 Originally publishedMay 27, 2008 PDF download Advertisement SubjectsCardiovascular SurgeryComputerized Tomography (CT)Congenital Heart DiseaseImaging
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