Evaluation of Marfan patients status post valve-sparing aortic root replacement with 4D flow

Thomas A. Hope*, John Peder Escobar Kvitting, Michael D. Hope, D. Craig Miller, Michael Markl, Robert J. Herfkens

*Corresponding author for this work

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Background: Over the past two decades elective valve-sparing aortic root replacement (V-SARR) has become more common in the treatment of patients with aortic root and ascending aortic aneurysms. Currently there are little data available to predict complications in the post-operative population. The study goal was to determine if altered flow patterns in the thoracic aorta, as measured by MRI, are associated with complications after V-SARR. Methods: Time-resolved three-dimensional phase-contrast MRI (4D flow) was used to image 12 patients with Marfan syndrome after V-SARR. The patients were followed up for an average of 5.8. years after imaging and 8.2. years after surgery. Additionally 5 volunteers were imaged for comparison. Flow profiles were visualized during peak systole using streamlines. Wall shear stress estimates and normalized flow displacement were evaluated at multiple planes in the thoracic aorta. Results: During the follow-up period, a single patient developed a Stanford Type B aortic dissection. At initial imaging, prior to the development of the dissection, the patient had altered flow patterns, wall shear stress estimates, and increased normalized flow displacement in the thoracic aorta in comparison to the remaining V-SARR patients and volunteers. Conclusions: This is the first follow-up study of patients after 4D flow imaging. An aortic dissection developed in one patient with altered flow patterns and hemodynamic stresses in the thoracic aorta. These results suggest that flow and altered hemodynamics may play a role in the development of post-operative intramural hematomas and dissections.

Original languageEnglish (US)
Pages (from-to)1479-1484
Number of pages6
JournalMagnetic Resonance Imaging
Volume31
Issue number9
DOIs
StatePublished - Nov 1 2013

Keywords

  • Aortic dissection
  • Magnetic resonance imaging
  • Marfan syndrome
  • Phase contrast
  • Valve-sparing aortic root replacement

ASJC Scopus subject areas

  • Biophysics
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging

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