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

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

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Copyright © 2023 Wiesemann, Trauzeddel, Musa, Hickstein, Mayr, von Knobelsdorff-Brenkenhoff, Bollache, Markl and Schulz-Menger.

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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.