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European Radiology
Erschienen in:

12.05.2021 | Magnetic Resonance

Leaflet fusion length is associated with aortic dilation and flow alterations in non-dysfunctional bicuspid aortic valve

verfasst von: Andrea Guala, Arturo Evangelista, Gisela Teixido-Tura, Lucia La Mura, Lydia Dux-Santoy, Aroa Ruiz-Muñoz, Filipa Valente, Laura Galian-Gay, Laura Gutiérrez, Teresa González-Alujas, Ilaria Dentamaro, Kevin M. Johnson, Oliver Wieben, Augusto Sao Avilés, Ignacio Ferreira-Gonzalez, Jose F. Rodríguez-Palomares

Erschienen in: European Radiology | Ausgabe 12/2021

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Abstract

Objective

Bicuspid aortic valve (BAV), the most common congenital valve defect, is associated with increased risk of aortic dilation and related complications; however, current risk assessment is not effective. Most of BAV have three leaflets with a fusion between two of them of variable length. This study aimed to ascertain whether the extent of leaflet fusion (often called raphe) is related to aortic dilation and flow abnormalities in BAV with no significant valvular dysfunction.

Methods

One hundred and twenty BAV patients with no significant valvular dysfunction or history of surgical repair or aortic valve replacement were consecutively and prospectively enrolled (September 2014–October 2018). Cardiac magnetic resonance protocol included a 4D flow sequence for haemodynamic assessment. Moreover, a stack of double-oblique cine images of the aortic valve were used to quantify fusion length (in systole) and leaflet length (diastole). Inter- and intra-observer reproducibility was tested in 30 randomly selected patients.

Results

Aortic valve leaflet fusion was measurable in 112 of 120 (93%) cases with good reproducibility (ICC = 0.826). Fusion length varied greatly (range: 2.3–15.4 mm; mean: 7.8 ± 3.2 mm). After correction for demographic and clinical conditions, fusion length was independently associated with diameter and z-score at the sinus of Valsalva (p = 0.002 and p = 0.002, respectively) and ascending aorta (p = 0.028 and p = 0.046). Fusion length was positively related to flow asymmetry, vortices and circumferential wall shear stress, thereby possibly providing a pathophysiological link with aortic dilation.

Conclusions

Aortic valve fusion length is related to aortic dilation and flow abnormalities in BAV patients.

Key Points

• The length of the fusion between leaflets in non-dysfunctional bicuspid aortic valves varies substantially and can be reliably measured by cine CMR.
• Aortic valve leaflet fusion length is independently related to aortic sinus and ascending aorta diameter.
• Increased flow asymmetry, circumferential wall shear stress and presence of vortices are positively related to aortic valve leaflet fusion length.
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Metadaten
Titel
Leaflet fusion length is associated with aortic dilation and flow alterations in non-dysfunctional bicuspid aortic valve
verfasst von
Andrea Guala
Arturo Evangelista
Gisela Teixido-Tura
Lucia La Mura
Lydia Dux-Santoy
Aroa Ruiz-Muñoz
Filipa Valente
Laura Galian-Gay
Laura Gutiérrez
Teresa González-Alujas
Ilaria Dentamaro
Kevin M. Johnson
Oliver Wieben
Augusto Sao Avilés
Ignacio Ferreira-Gonzalez
Jose F. Rodríguez-Palomares
Publikationsdatum
12.05.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 12/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-021-08016-3

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