JTCVS structural and endovascular · 2024
Restoration of 3-dimensional aortic hemodynamics after the Ross procedure for unicuspid aortic valve disease using 4-dimensional flow magnetic resonance imaging.
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Zbihley Andrew, Maroun Anthony, Baraboo Justin J, Johnson Ethan, Shi Meilynn, Allen Bradley D, Markl Michael, Malaisrie S Chris, Mehta Christopher K
Аннотация
BACKGROUND: In the past decade, the Ross procedure has reemerged as a promising approach for young adult patients with aortic valve disease. We evaluated its efficacy in restoration of selected aortic hemodynamic parameters in patients with unicuspid aortic valve (UAV) using 4-dimensional (4D) flow magnetic resonance imaging (MRI). This study examined whether the Ross procedure would normalize ascending aorta (AAo) hemodynamics in patients with UAV.
METHODS: Thirteen patients with UAV disease who underwent the Ross procedure and received preoperative and postoperative 4D flow MRI were matched to healthy controls (n = 52). Systolic peak velocity (PV), wall shear stress, and viscous energy loss (EL) of each MRI were assessed and compared.
RESULTS: There was a significant decrease in systolic PV in the AAo postoperatively (P < .0001), suggesting that the Ross procedure normalizes high flow velocities and gradients across the aortic valve and aorta. This study also found a significant global reduction in systolic viscous EL in the thoracic aorta postoperatively (P < .01), suggesting that the Ross procedure reduces the turbulence of blood flow through the aorta. Additionally, no differences in these variables were seen between postoperative patients and healthy controls.
CONCLUSIONS: This study demonstrates the value of using 4D flow MRI to understand aortic hemodynamics after the Ross procedure. Additionally, this study shows that in patients with UAV disease, the Ross procedure can normalize aortic hemodynamics similar to healthy controls.
METHODS: Thirteen patients with UAV disease who underwent the Ross procedure and received preoperative and postoperative 4D flow MRI were matched to healthy controls (n = 52). Systolic peak velocity (PV), wall shear stress, and viscous energy loss (EL) of each MRI were assessed and compared.
RESULTS: There was a significant decrease in systolic PV in the AAo postoperatively (P < .0001), suggesting that the Ross procedure normalizes high flow velocities and gradients across the aortic valve and aorta. This study also found a significant global reduction in systolic viscous EL in the thoracic aorta postoperatively (P < .01), suggesting that the Ross procedure reduces the turbulence of blood flow through the aorta. Additionally, no differences in these variables were seen between postoperative patients and healthy controls.
CONCLUSIONS: This study demonstrates the value of using 4D flow MRI to understand aortic hemodynamics after the Ross procedure. Additionally, this study shows that in patients with UAV disease, the Ross procedure can normalize aortic hemodynamics similar to healthy controls.