Effect of Aortic Valve Disease on 3D Hemodynamics in Patients With Aortic Dilation and Trileaflet Aortic Valve Morphology

Kenichiro Suwa*, Ozair Abdul Rahman, Emilie Bollache, Michael J. Rose, Amir Ali Rahsepar, James C. Carr, Jeremy D. Collins, Alex J. Barker, Michael Markl

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The effect of different expressions of aortic valve disease on 3D aortic hemodynamics is unclear. Purpose: To investigate changes in aortic hemodynamics in patients with dilated ascending aorta (AAo) but different severity of aortic valve stenosis (AS) and/or regurgitation (AR). Study Type: Retrospective. Population: A total of 111 subjects (86 patients with AAo diameter ≥ 40 mm and 25 healthy controls, all with trileaflet aortic valve [TAV]). Patients were further stratified by TAV dysfunction: n = 9 with combined moderate or severe AS and AR (ASR, 56 ± 13 years), n = 14 with moderate or severe AS (AS, 64 ± 14 years), n = 33 with moderate or severe AR (AR, 62 ± 14 years), n = 30 with neither AS nor AR (no AS/AR, 63 ± 9 years). Field Strength/Sequence: 4D flow MRI on 1.5/3T systems for the in vivo analysis of aortic blood flow dynamics. Assessment: Data analysis included grading of 3D AAo vortex/helix flow and AAo flow eccentricity as well as quantification of systolic peak velocities and wall shear stress (WSS). Statistical Tests: Continuous variables were compared by one-way analysis of variance or Kruskal–Wallis, followed by a pairwise Tukey or Dunn test if there was a significant difference. Results: All patients demonstrated markedly elevated vortex and helix flow compared with controls (P < 0.05). Peak velocities were significantly elevated in ASR, AS, and AR patients compared with controls (P < 0.05). Increased flow eccentricity was observed in entire AAo for AR, at the mid and distal AAo for ASR and AS, and at the proximal AAo for no AS/AR. Compared with controls, WSS in the AAo was significantly elevated in ASR and AS patients (P < 0.05) and reduced in no AS/AR patients (P < 0.05). Data Conclusion: The presence of TAV dysfunction is associated with aberrant hemodynamics and altered WSS, which may play a role in the development of aortopathy. Level of Evidence: 3. Technical Efficacy Stage: 3. J. Magn. Reson. Imaging 2020;51:481–491.

Original languageEnglish (US)
Pages (from-to)481-491
Number of pages11
JournalJournal of Magnetic Resonance Imaging
Issue number2
StatePublished - Feb 1 2020


  • 4D flow MRI
  • aortic dilatation
  • aortic valve regurgitation
  • aortic valve stenosis
  • hemodynamics
  • wall shear stress

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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