HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): D. Craig Miller Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Markl, M. Articles by Herfkens, R. J. Search for Related Content PubMed PubMed Citation Articles by Markl, M. Articles by Herfkens, R. J. Related Collections Valve disease

J Thorac Cardiovasc Surg 2005;130:456-463
© 2005 The American Association for Thoracic Surgery

Evolving Technology

Time-resolved three-dimensional magnetic resonance velocity mapping of aortic flow in healthy volunteers and patients after valve-sparing aortic root replacement

^a Department of Radiology, Stanford University, Stanford, Calif.
^b Department of Mechanical Engineering, Stanford University, Stanford, Calif.
^c Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
^d Division of Cardiovascular Medicine, Stanford University, Stanford, Calif.

Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23–26, 2004.

Received for publication April 27, 2004; revisions received August 11, 2004; accepted for publication August 20, 2004.

^_* Address for reprints: Robert J. Herfkens MD, Stanford University, Department of Radiology, Lucas MRI/S Center, P263, Palo Alto, CA 94304. (Email: herfkens{at}stanford.edu).

OBJECTIVE: To provide more complete characterization of ascending aortic blood flow, including vortex formation behind the valve cusps, in healthy subjects and patients after valve-sparing aortic root replacement (David reimplantation).

METHODS: Time-resolved 3-dimensional magnetic resonance imaging velocity mapping was performed to analyze pulsatile blood flow by using encoded 3-directional vector fields in the thoracic aortas of 10 volunteers and 12 patients after David reimplantation using a cylindrical tube graft (T. David I) and two versions of neosinus recreation (T. David-V and T. David-V-S_mod). Aortic flow was evaluated by using 3-dimensional time-resolved particle traces and velocity vector fields reformatted onto 2-dimensional planes. Semiquantitative data were derived by using a blinded grading system (0–3: 0, none; 1, minimal; 2, medium; 3, prominent) to analyze the systolic vortex formation behind the cusps, as well as retrograde and helical flow in the ascending aorta.

RESULTS: Systolic vortices were seen in both coronary sinuses of all volunteers (greater in the left sinus [2.5 ± 0.5] than the right [1.8 ± 0.8]) but in only 4 of 10 noncoronary sinuses (0.7 ± 0.9). Comparable coronary vortices were detected in all operated patients. Vorticity was minimal in the noncoronary cusp in T. David-I repairs (0.7 ± 0.7) but was prominent in T. David-V noncoronary graft pseudosinuses (1.5 ± 0.6; P = .035). Retrograde flow (P = .001) and helicity (P = .028) were found in all patients but were not distinguishable from normal values in the T. David-V-S_mod patients.

CONCLUSIONS: Coronary cusp vorticity was preserved after David reimplantation, regardless of neosinus creation. Increased retrograde flow and helicity were more prominent in T. David-V patients. These novel magnetic resonance imaging methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing various types of valve-sparing aortic root replacement.

This article has been cited by other articles:

				L. G. Svensson, M. Cooper, L. H. Batizy, and E. R. Nowicki Simplified David Reimplantation With Reduction of Anular Size and Creation of Artificial Sinuses Ann. Thorac. Surg., May 1, 2010; 89(5): 1443 - 1447. [Abstract] [Full Text] [PDF]

				A. Frydrychowicz, A. Berger, A. F. Stalder, and M. Markl Preliminary results by flow-sensitive magnetic resonance imaging after Tiron David I procedure with an anatomically shaped ascending aortic graft Interact CardioVasc Thorac Surg, August 1, 2009; 9(2): 155 - 158. [Abstract] [Full Text] [PDF]

				S. Katayama, N. Umetani, S. Sugiura, and T. Hisada The sinus of Valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1528 - 1535. [Abstract] [Full Text] [PDF]

				E. Weigang, F. A. Kari, F. Beyersdorf, M. Luehr, C. D. Etz, A. Frydrychowicz, A. Harloff, and M. Markl Flow-sensitive four-dimensional magnetic resonance imaging: flow patterns in ascending aortic aneurysms Eur J Cardiothorac Surg, July 1, 2008; 34(1): 11 - 16. [Abstract] [Full Text] [PDF]

				M. Markl, C. Benk, D. Klausmann, A. F. Stalder, A. Frydrychowicz, J. Hennig, and F. Beyersdorf Three-dimensional magnetic resonance flow analysis in a ventricular assist device. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1471 - 1476. [Abstract] [Full Text] [PDF]

				B. E. Muhs, H. J. M. Verhagen, M. G. Huddle, V. M. Pai, E. M. Hecht, and A. Dardik Theory, Technique, and Practice of Magnetic Resonance Angiography Vascular, December 1, 2007; 15(6): 376 - 383. [Abstract] [Full Text] [PDF]

				L. Grosse-Wortmann, A. Al-Otay, H. Woo Goo, C. K. Macgowan, J. G. Coles, L. N. Benson, A. N. Redington, and S.-J. Yoo Anatomical and Functional Evaluation of Pulmonary Veins in Children by Magnetic Resonance Imaging J. Am. Coll. Cardiol., March 6, 2007; 49(9): 993 - 1002. [Abstract] [Full Text] [PDF]

				S. Wetzel, S. Meckel, A. Frydrychowicz, L. Bonati, E.-W. Radue, K. Scheffler, J. Hennig, and M. Markl In Vivo Assessment and Visualization of Intracranial Arterial Hemodynamics with Flow-Sensitized 4D MR Imaging at 3T AJNR Am. J. Neuroradiol., March 1, 2007; 28(3): 433 - 438. [Abstract] [Full Text] [PDF]

				F. Bakhtiary, M. Schiemann, O. Dzemali, S. Dogan, V. Schachinger, H. Ackermann, A. Moritz, and P. Kleine Impact of Patient-Prosthesis Mismatch and Aortic Valve Design on Coronary Flow Reserve After Aortic Valve Replacement J. Am. Coll. Cardiol., February 20, 2007; 49(7): 790 - 796. [Abstract] [Full Text] [PDF]

				D. C. Miller Valve-Sparing Aortic Root Replacement: Current State of the Art and Where Are We Headed? Ann. Thorac. Surg., February 1, 2007; 83(2): S736 - S739. [Full Text] [PDF]

				T. N. Fitzgerald, A. Muto, F. A. Kudo, J. M. Pimiento, R. T. Constable, and A. Dardik Emerging Vascular Applications of Magnetic Resonance Imaging: A Picture is Worth More than a Thousand Words Vascular, November 1, 2006; 14(6): 366 - 371. [Abstract] [Full Text] [PDF]

				A. Ranga, O. Bouchot, R. Mongrain, P. Ugolini, and R. Cartier Computational simulations of the aortic valve validated by imaging data: evaluation of valve-sparing techniques Interact CardioVasc Thorac Surg, August 1, 2006; 5(4): 373 - 378. [Abstract] [Full Text] [PDF]

				F. Bakhtiary, M. Schiemann, O. Dzemali, T. Wittlinger, M. Doss, H. Ackermann, A. Moritz, and P. Kleine Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 883 - 888. [Abstract] [Full Text] [PDF]