title: Correlation between systolic transvalvular flow and proximal aortic wall changes in bicuspid aortic valve stenosis.
abstract: OBJECTIVE
  The purpose of this study was to analyse the correlation between preoperative systolic transvalvular flow patterns and proximal aortic wall lesions in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis.
  
  
  METHODS
  A total of 48 consecutive patients with BAV stenosis (mean age 58 ± 9 years, 65% male) underwent aortic valve replacement (AVR) ± proximal aortic surgery from January 2012 through February 2013. Preoperative cardiac phase-contrast cine magnetic resonance imaging (MRI) assessment was performed in all patients in order to detect the area of maximal flow-induced stress in the proximal aorta. Based on these MRI data, two aortic wall samples (i.e. area of the maximal stress (jet sample) and the opposite aortic wall (control sample)) were collected during AVR surgery. Aortic wall changes were graded based on a summation of seven histological criteria (each scored from 0 to 3). Histological sum score (0-21) was separately calculated and compared between the two aortic samples (i.e. jet sample vs control sample).
  
  
  RESULTS
  An eccentric transvalvular flow jet hitting the proximal aortic wall could be identified in all 48 (100%) patients. The mean histological sum score was significantly higher in the jet sample vs control sample areas of the aorta (i.e. 4.1 ± 1.8 vs 2.2 ± 1.5, respectively) (P = 0.02). None of the patients had a higher sum score value in the control sample.
  
  
  CONCLUSIONS
  Our study demonstrates a strong correlation between the systolic pattern of the transvalvular flow jet and asymmetric proximal aortic wall changes in patients undergoing AVR for BAV stenosis.
authors.affiliation: Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany egirdauskas@web.de.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Girdauskas
authors.affiliation: Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
authors.forename: Mina
authors.initials: M
authors.lastname: Rouman
authors.affiliation: Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
authors.forename: Kushtrim
authors.initials: K
authors.lastname: Disha
authors.affiliation: Department of Radiology, Central Clinic Bad Berka, Bad Berka, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Scholle
authors.affiliation: Department of Radiology, Central Clinic Bad Berka, Bad Berka, Germany.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Fey
authors.affiliation: Institute of Pathology, Friedrich-Schiller University Jena, Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Theis
authors.affiliation: Institute of Pathology, Friedrich-Schiller University Jena, Jena, Germany.
authors.forename: Iver
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013599:Systole / Q000502:physiology
keywords: Aorta; Aortic aneurysm; Aortopathy; Bicuspid aortic valve