Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance

• Type of Material: Article
• Authors: P Martijn den Reijer, Emory University; Denver Sallee, Emory University; Petra van der Velden, Leiden University; Eline R. Zaaijer, Leiden University; Willie James Parks, Emory University; Senthil Ramamurthy, Children's Healthcare of Atlanta; Trevor Q. Robbie, Emory University; Giorgina Donati, Emory University; Carey Lamphier, Emory University; Rudolf P. Beekman, Leiden University; Marijn E. Brummer, Emory University
• Language: English
• Date: 2010-01-13
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2010 den Reijer et al; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.jcmr-online.com/content/12/1/4
• Title of Journal or Parent Work: Journal of Cardiovascular Magnetic Resonance
• ISSN: 1097-6647
• Volume: 12
• Issue: 4
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

Background Congenital Bicuspid Aortic Valve (BAV) is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available. Methods This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease. Results The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees) than controls (10.01 ± 1.29) (p = 0.01). Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048), AAO: r = 0.536 (N = 18, p = 0.022), and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033), STJ: r = 0.562 (N = 28, p = 0.002), and AAO r = 0.645 (N = 28, p < 0.001). Dilatation and the flow jet angle were also found to correlate with plasma levels of matrix metallo-proteinase 2. Conclusions The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.