Aortic flow after valve sparing root replacement with or without neosinuses reconstruction
This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses. We enrolled patients after valve sparing root replacement with a straight...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2019-02, Vol.157 (2), p.455-465 |
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| creator | Gaudino, Mario Piatti, Filippo Lau, Christopher Sturla, Francesco Weinsaft, Jonathan W. Weltert, Luca Votta, Emiliano Galea, Nicola Chirichilli, Ilaria Di Franco, Antonino Francone, Marco Catalano, Carlo Redaelli, Alberto Girardi, Leonard N. De Paulis, Ruggero |
| description | This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses.
We enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group.
Physiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P |
| doi_str_mv | 10.1016/j.jtcvs.2018.06.094 |
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We enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group.
Physiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P < .001 vs control). In the ascending aorta, recreation of the sinuses resulted in significantly lower velocity and WSS than in the straight tubular graft (P < .001) and controls (P < .001), these alterations were attenuated in the mid-descending aorta. Incidence of abnormal WSS was markedly higher in the straight tube grafts than neosinus of Valsalva grafts.
Re-creation of the sinuses of Valsalva during valve-sparing root replacement is associated with more physiologic flow and significantly lower WSS in the aortic root. Lower WSSs in the distal thoracic aorta is a novel finding with potential implications on distal aortic remodeling.
[Display omitted]</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2018.06.094</identifier><identifier>PMID: 30139642</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>4D MRI ; aorta ; flow ; valve-sparing surgery</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2019-02, Vol.157 (2), p.455-465</ispartof><rights>2018 The American Association for Thoracic Surgery</rights><rights>Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-a6fd78513ec620784f526795ba6d796af41614ebcc9b8ec6be34f62abe6b9be73</citedby><cites>FETCH-LOGICAL-c404t-a6fd78513ec620784f526795ba6d796af41614ebcc9b8ec6be34f62abe6b9be73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522318320269$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30139642$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gaudino, Mario</creatorcontrib><creatorcontrib>Piatti, Filippo</creatorcontrib><creatorcontrib>Lau, Christopher</creatorcontrib><creatorcontrib>Sturla, Francesco</creatorcontrib><creatorcontrib>Weinsaft, Jonathan W.</creatorcontrib><creatorcontrib>Weltert, Luca</creatorcontrib><creatorcontrib>Votta, Emiliano</creatorcontrib><creatorcontrib>Galea, Nicola</creatorcontrib><creatorcontrib>Chirichilli, Ilaria</creatorcontrib><creatorcontrib>Di Franco, Antonino</creatorcontrib><creatorcontrib>Francone, Marco</creatorcontrib><creatorcontrib>Catalano, Carlo</creatorcontrib><creatorcontrib>Redaelli, Alberto</creatorcontrib><creatorcontrib>Girardi, Leonard N.</creatorcontrib><creatorcontrib>De Paulis, Ruggero</creatorcontrib><title>Aortic flow after valve sparing root replacement with or without neosinuses reconstruction</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses.
We enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group.
Physiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P < .001 vs control). In the ascending aorta, recreation of the sinuses resulted in significantly lower velocity and WSS than in the straight tubular graft (P < .001) and controls (P < .001), these alterations were attenuated in the mid-descending aorta. Incidence of abnormal WSS was markedly higher in the straight tube grafts than neosinus of Valsalva grafts.
Re-creation of the sinuses of Valsalva during valve-sparing root replacement is associated with more physiologic flow and significantly lower WSS in the aortic root. Lower WSSs in the distal thoracic aorta is a novel finding with potential implications on distal aortic remodeling.
[Display omitted]</description><subject>4D MRI</subject><subject>aorta</subject><subject>flow</subject><subject>valve-sparing surgery</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kLFu2zAQhokiRe2kfYIAAccsUo-kRIlDBsNImwAGurRA0YWgqFNLQxYdknLQtw9jJxkz_ct39999hFwyKBkw-XVbbpM9xJIDa0uQJajqA1kyUE0h2_r3GVkCcF7UnIsFOY9xCwANMPWJLAQwoWTFl-TPyofkLB1G_0jNkDDQgxkPSOPeBDf9pcH7RAPuR2Nxh1Oijy79oz4c08-JTuijm-aIMWPWTzGF2Sbnp8_k42DGiF9e8oL8-nb7c31XbH58v1-vNoWtoEqFkUPftDUTaCWHpq2GmstG1Z2RfaOkGSomWYWdtaprM9OhqAbJTYeyUx024oJcn_bug3-YMSa9c9HiOJp82hw1ByUENLytMypOqA0-xoCD3ge3M-G_ZqCfpeqtPkrVz1I1SJ2l5qmrl4K522H_NvNqMQM3JwDzmweHQUfrcLLYu6wk6d67dwueAAfWjAM</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Gaudino, Mario</creator><creator>Piatti, Filippo</creator><creator>Lau, Christopher</creator><creator>Sturla, Francesco</creator><creator>Weinsaft, Jonathan W.</creator><creator>Weltert, Luca</creator><creator>Votta, Emiliano</creator><creator>Galea, Nicola</creator><creator>Chirichilli, Ilaria</creator><creator>Di Franco, Antonino</creator><creator>Francone, Marco</creator><creator>Catalano, Carlo</creator><creator>Redaelli, Alberto</creator><creator>Girardi, Leonard N.</creator><creator>De Paulis, Ruggero</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201902</creationdate><title>Aortic flow after valve sparing root replacement with or without neosinuses reconstruction</title><author>Gaudino, Mario ; Piatti, Filippo ; Lau, Christopher ; Sturla, Francesco ; Weinsaft, Jonathan W. ; Weltert, Luca ; Votta, Emiliano ; Galea, Nicola ; Chirichilli, Ilaria ; Di Franco, Antonino ; Francone, Marco ; Catalano, Carlo ; Redaelli, Alberto ; Girardi, Leonard N. ; De Paulis, Ruggero</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-a6fd78513ec620784f526795ba6d796af41614ebcc9b8ec6be34f62abe6b9be73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>4D MRI</topic><topic>aorta</topic><topic>flow</topic><topic>valve-sparing surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gaudino, Mario</creatorcontrib><creatorcontrib>Piatti, Filippo</creatorcontrib><creatorcontrib>Lau, Christopher</creatorcontrib><creatorcontrib>Sturla, Francesco</creatorcontrib><creatorcontrib>Weinsaft, Jonathan W.</creatorcontrib><creatorcontrib>Weltert, Luca</creatorcontrib><creatorcontrib>Votta, Emiliano</creatorcontrib><creatorcontrib>Galea, Nicola</creatorcontrib><creatorcontrib>Chirichilli, Ilaria</creatorcontrib><creatorcontrib>Di Franco, Antonino</creatorcontrib><creatorcontrib>Francone, Marco</creatorcontrib><creatorcontrib>Catalano, Carlo</creatorcontrib><creatorcontrib>Redaelli, Alberto</creatorcontrib><creatorcontrib>Girardi, Leonard N.</creatorcontrib><creatorcontrib>De Paulis, Ruggero</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gaudino, Mario</au><au>Piatti, Filippo</au><au>Lau, Christopher</au><au>Sturla, Francesco</au><au>Weinsaft, Jonathan W.</au><au>Weltert, Luca</au><au>Votta, Emiliano</au><au>Galea, Nicola</au><au>Chirichilli, Ilaria</au><au>Di Franco, Antonino</au><au>Francone, Marco</au><au>Catalano, Carlo</au><au>Redaelli, Alberto</au><au>Girardi, Leonard N.</au><au>De Paulis, Ruggero</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Aortic flow after valve sparing root replacement with or without neosinuses reconstruction</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2019-02</date><risdate>2019</risdate><volume>157</volume><issue>2</issue><spage>455</spage><epage>465</epage><pages>455-465</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses.
We enrolled patients after valve sparing root replacement with a straight tubular prosthesis (n = 10) or with a prosthesis with Valsalva neosinuses (n = 10); age-matched subjects without cardiovascular diseases served as controls (n = 10). 4-Dimensional flow magnetic resonance imaging acquisitions were performed on a 3.0T magnetic resonance imaging unit. In-house processing was used to segment the aortic lumen and extract the volumetric 4-dimensional flow velocity field. Velocity flow streamlines were computed to compare the amount of rotational flow and wall shear stress. Occurrence of abnormal wall shear stress (WSS) was estimated within the descending aorta of each surgical group.
Physiologic-like sinus vortices were visible in the aortic root when using the prosthesis with neosinuses, whereas straight tubular graft revealed localized intrados malrotations (P = .003 for organized vortical structures vs neosinuses graft and P < .001 vs control). In the ascending aorta, recreation of the sinuses resulted in significantly lower velocity and WSS than in the straight tubular graft (P < .001) and controls (P < .001), these alterations were attenuated in the mid-descending aorta. Incidence of abnormal WSS was markedly higher in the straight tube grafts than neosinus of Valsalva grafts.
Re-creation of the sinuses of Valsalva during valve-sparing root replacement is associated with more physiologic flow and significantly lower WSS in the aortic root. Lower WSSs in the distal thoracic aorta is a novel finding with potential implications on distal aortic remodeling.
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| subjects | 4D MRI aorta flow valve-sparing surgery |
| title | Aortic flow after valve sparing root replacement with or without neosinuses reconstruction |
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