Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: implications for aortic valve-sparing surgery.
OBJECTIVE
Sparing the aortic valve has become a surgical option for patients who require repair of aortic root ectasia and have normal valve leaflets. Surgical approaches to valve sparing differ with regard to preservation of the native sinuses of Valsalva. The role of the sinuses and the importance of maintaining them remain controversial.


METHODS
By using a time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging technique, aortic root and aortic blood velocity data were acquired from 2 patients with Marfan syndrome 6 months after aortic valve-sparing surgery with straight Dacron grafts and contrasted with data from 6 normal volunteers.


RESULTS
In normal aortas vortical blood flow became apparent in the individual sinuses after peak systole. The vortices filled the available space behind the valve leaflets and persisted until diastole, expanding and moving inward during aortic valve closure. In contrast, no vortices were observed in the postoperative patients with Marfan syndrome with negligible sinuses.


CONCLUSIONS
Changes in supravalvular flow accompany loss of sinus architecture. Whether the presence, size, and velocity of supravalvular vortices affects the function or durability of the preserved aortic valve remains to be studied.
Kvitting
John-Peder Escobar
JP
Department of Clinical Physiology, Linköping University Hospital, Linkoping, Sweden. johnkv@imv.liu.se
Ebbers
Tino
T
Wigström
Lars
L
Engvall
Jan
J
Olin
Christian L
CL
Bolger
Ann F
AF
D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D003287:Contrast Media; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008382:Marfan Syndrome / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D011336:Probability; D011856:Radiographic Image Enhancement / Q000379:methods*; D012016:Reference Values; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D003287:Contrast Media